Table 4 Preventive migraine treatment
Drug class | Drug | Dosage and route | Contraindications |
|---|---|---|---|
First-line medication | |||
Beta blockers | Atenolol | 25–100 mg oral twice daily | Asthma, cardiac failure, Raynaud disease, atrioventricular block, depression |
Bisoprolol | 5–10 mg oral once daily | ||
Metoprolol | 50–100 mg oral twice daily or 200 mg modified-release oral once daily | ||
Propranolol | 80–160 mg oral once or twice daily in long-acting formulations | ||
Angiotensin II-receptor blocker | Candesartan | 16–32 mg oral per day | Co-administration of aliskiren |
Anticonvulsant | Topiramate | 50–100 mg oral daily | Nephrolithiasis, pregnancy, lactation, glaucoma |
Second-line medication | |||
Tricyclic antidepressant | Amitriptyline | 10–100 mg oral at night | Age <6 years, heart failure, co-administration with monoamine oxidase inhibitors and SSRIs, glaucoma |
Calcium antagonist | Flunarizine | 5–10 mg oral once daily | Parkinsonism, depression |
Anticonvulsant | Sodium valproatea | 600–1,500 mg oral once daily | Liver disease, thrombocytopenia, female and of childbearing potential |
Third-line medication | |||
Botulinum toxin | OnabotulinumtoxinA | 155–195 units to 31–39 sites every 12 weeks | Infection at injection site |
Calcitonin gene-related peptide monoclonal antibodies | Erenumab | 70 or 140 mg subcutaneous once monthly | Hypersensitivity Not recommended in patients with a history of stroke, subarachnoid haemorrhage, coronary heart disease, inflammatory bowel disease, chronic obstructive pulmonary disease or impaired wound healing |
Fremanezumab | 225 mg subcutaneous once monthly or 675 mg subcutaneous once quarterly | ||
Galcanezumab | 240 mg subcutaneous, then 120 mg subcutaneous once monthly | ||
Eptinezumab | 100 or 300 mg intravenous quarterly | ||
