neurologic disorders
Migraine
Prevention of Migraine
Daily preventive therapy is warranted when frequent migraines interfere with activity despite acute treatment. Some experts consideronabotulinumtoxinAthe drug of choice. For patients who use analgesics frequently (eg, > 2 days/week), particularly those with medication overuse headache, preventive drugs should be combined with a program for stopping overused analgesics. Choice of medication can be guided by coexisting disorders, as for the following: A bedtime dose ofamitriptylinefor patients with insomnia A beta-blocker for patients with anxiety or coronary artery disease Topiramate, which can induce weight loss, for patients with obesity or for patients who wish to avoid weight gain A monoclonal antibody (eg,erenumab,fremanezumab,galcanezumab) if other medications are ineffective Gepants can be used for acute attacks (ubrogepant,rimegepant) and prevention (atogepant,rimegepant) of migraine gene-related peptide (CGRP), which can precipitate migraines ( Prevention references ). Neuromodulatory treatments can also help. Transcutaneous supraorbital nerve stimulation, using a device applied to the forehead, can reduce the frequency of migraines ( Prevention references ). Transcranial magnetic stimulation, using by a device applied to the back of the skull, is indicated for the acute and prophylactic treatment of migraine headache in adolescents (≥ 12) and adults. 1.Jain S, Silberstein SD: Invited commentary on preventive anti-migraine therapy (PAMT).Curr Treat Options Neurol21 (4):14, 2019. doi:10.1007/s11940-019-0555-4. 2.Schoenen J, Vandersmissen B, Jeangette S, et al: Migraine prevention with a supraorbital transcutaneous stimulator: A randomized controlled trial.Neurol80 (8):697–704, 2013. doi: https://doi.org/10.1212/WNL.0b013e3182825055 