ACP Issues Clinical Guideline for Pharmacologic Prevention of Episodic Migraine

MONDAY, Feb. 10, 2025 (HealthDay News) — In a clinical guideline issued by the American College of Physicians and published online Feb. 4 in the Annals of Internal Medicine, recommendations are presented regarding the use of pharmacologic treatments for the prevention of episodic migraine headache in nonpregnant adults in outpatient settings.

Amir Qaseem, M.D., Ph.D., from the American College of Physicians in Philadelphia, and colleagues examined the comparative effectiveness of medications that are beneficial for preventing episodic migraine to help clinicians select which medication to use.

The guidelines include three recommendations. Monotherapy to prevent episodic migraine headache in nonpregnant adults in outpatient settings is suggested by choosing one of the following: beta-adrenergic blocker (metoprolol or propranolol), the antiseizure medication valproate, the serotonin and norepinephrine reuptake inhibitor venlafaxine, or the tricyclic antidepressant amitriptyline. To prevent episodic migraine headache in nonpregnant adults in outpatient settings who do not tolerate or inadequately respond to a trial or trials of one of these medications, monotherapy with a calcitonin gene-related peptide (CGRP) antagonist-gepant or a CGRP monoclonal antibody is suggested. Monotherapy with the antiseizure medication topiramate is suggested to prevent episodic migraine for those who do not respond to the suggestions in recommendations 1 and 2. An informed decision-making approach should be used, and benefits, harms, costs, patient values and preferences, contraindications, pregnancy and reproductive status in females, clinical comorbidities, and medication availability should be discussed when selecting pharmacologic treatment.

“Adherence to pharmacologic treatment is crucial because improvement may occur gradually after initiation of a long-term treatment option for prevention of episodic migraine, with an effect that may become apparent after the first few weeks of treatment,” the authors write.

Clinical Guideline

Evidence Review 1 (subscription or payment may be required)

Evidence Review 2 (subscription or payment may be required)