Fast Five Quiz: Migraine Prevention and Treatment

Helmi L. Lutsep, MD


February 04, 2022

For migraine prevention, CGRP antagonists were the first drugs developed specifically to prevent migraine in adults. They are delivered by injection or, in the case of eptinezumab-jjmr, by infusion, either every month or every 3 months. Ubrogepant is the first CGRP approved for the acute treatment of migraine. Rimegepant is another oral CGRP antagonist, approved in February 2020, for acute treatment.

Additionally, antiepileptic drugs, including divalproex sodium, sodium valproate, and topiramate, are supported by strong evidence of effectiveness. There is also strong evidence that beta-blockers, including metoprolol, propranolol, and timolol are effective. Other effective preventive medications include triptans.

Adherence to oral migraine prophylaxis is typically low, in part because the medications may be ineffective or poorly tolerated.

Although selective serotonin reuptake inhibitors (SSRIs) are widely used, data regarding their efficacy in migraine prevention are lacking; consequently, SSRIs are not recommended for migraine prevention. However, limited data do support the use of serotonin/norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine for migraine prevention.

For additional information, refer to the guidelines of the US Headache Consortium and the American Headache Society; and refer to the American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice updates.

Learn more about the prevention of migraines.


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