Many Medications Minimize Migraines

Migraine medication benefits tend to outweigh risks according to new study

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) There has been uncertainty about whether medications help prevent migraines in adults. A recent study was conducted to weigh the risks and benefits of various FDA-approved medications to reduce migraine headache frequency.

The researchers found that FDA-approved medications reduced episodic migraine frequency in patients by 50 percent or more.

An episodic migraine is a moderate to severe headache that occurs randomly. This is different than chronic migraines, which are like episodic migraines, but occur more frequently. Symptoms of episodic migraines include severe headaches, vomiting, stiff neck and mental confusion.

These findings of this study suggest that there are treatment options which may help reduce the frequency of episodic migraines.

"Ask your doctor about treatment for migraines."

Tatyana A. Shamliyan, MD, MS, a senior research associate at the Minnesota Evidence-Based Practice Center, and her colleagues aimed to provide an overview on the safety and effectiveness of pharmaceutical treatments for preventing migraines in adults.

These researchers assessed and compared hundreds of published medical trials that looked at medications used to reduce the frequency of migraines. The treatments were regarded as beneficial if patients reported a decrease of 50 percent or more in the frequency of their migraines. The study did not include medications used to stop migraine headaches after they started, such as triptans.

The study gathered approximately 5,244 different references and 215 publications. Of these publications, 76 were non-randomized clinical trials.

Nearly 59 different medications used to treat episodic migraines were used in these randomized clinical trials.

A randomized clinical trial is a study in which participants are assigned by chance to separate groups receiving different treatments. By randomly assigning similar participants to different treatments, researchers can objectively compare those treatments.

Randomized clinical trials are regarded as more reliable than other kinds of trials because they eliminate biases patients might have when choosing a particular treatment.

This study found that all of the FDA-approved medications were better at reducing migraine frequency by 50 percent compared to a placebo (fake medication). For every 1,000 patients, 200 to 400 patients reported that their migraines were less frequent after taking FDA-approved migraine medication.

The researchers also documented three off-label medications — acebutolol (brand name Sectral), atenolol (Tenormin) and nadolol (Corgard) — which helped decrease migraine frequency in patients by 50 percent or more.

An off-label medication is one that is used to treat a particular disease, illness or problem that the medication was not originally developed to treat. Acebutolol, atenolol, and nadolol are usually used to treat high blood pressure.

Approximately 256 out of 1,000 patients taking acebutolol reported a decrease of 50 percent or more in migraine frequency. The same was true for 333 out of 1,000 patients taking atenolol and 250 out of a 1,000 patients taking nadolol.

Of the FDA-approved medications that were reviewed, topiramate (brand name Topamax) had the worst side effects. Approximately 159 out of 18,134 adults reported negative side effects. Weight loss, fatigue and a change in taste buds were the most commonly reported negative side effects.

Evidence is lacking regarding the long-term benefits and risks of FDA-approved medications. The reviewed trials only documented the effects of preventive migraine medications on a group of patients for three months time.

Furthermore, the researchers did not contact the authors of each study for the risks and benefits that the medications might have had upon patients that went unreported.

Nevertheless, this research provides evidence for which therapeutic medications are beneficial to patients suffering from chronic to severe episodic migraines.

As Dr. Shamliyan and colleagues wrote, “Based on our comprehensive network analysis, we conclude that approved medications and off-label medications (lisinopril, captopril, candesartan) or off-label beta-blockers (metoprolol, acebutolol, atenolol, and nadolol) were effective in preventing migraines in adults.”

“Whenever one of my patients asks me about issues related to headache and/or migraine prevention, I take the opportunity for a quick assessment.  We talk about their specific symptoms and discuss their prior treatments, current medications and health status.  I then try to assure them that preventative medications can help," Jason Poquette, BPharm, RPh, told dailyRx News.

"Studies like this one are very valuable as I encourage patients to speak to their doctor about treatments which can help reduce the severity and frequency of their headache pain," said Poquette.

This study was published in the September issue of the Journal of General Internal Medicine. The study was funded by the University of Minnesota Evidence-Based Practice Center. The authors declared no conflicts of interest.

Review Date: 
August 22, 2013
Last Updated:
August 27, 2013