Approved drug treatments for chronic and episodic migraine are mostly effective. However, treatments boost the risk of adverse effects and treatment discontinuation due to those effects, according to a new research review by AHRQ’s Effective Health Care Program.
Episodic migraine is characterized by less than 15 migraine days per month and chronic migraine by 15 or more headache days per month. For episodic migraine, all approved drugs—such as topiramate, opiramate, divalproex, timolol, and propranolol—are effective in reducing monthly migraine frequency, but similarly increase risk of adverse effects and treatment discontinuation. For chronic migraine, the medicine onabotulinumtoxinA reduces migraine attacks by more than 50 percent, but increases the risk of adverse effects and treatment discontinuation due to those effects. Compared with approved migraine drugs, some off-label beta blockers and angiotensin inhibiting drugs are more effective and safer for preventing adult migraine.
The long-term preventive benefits and adherence with all drugs cannot be determined from available research. All migraine types significantly affect the physical, psychological, and social well-being of patients, and can impose serious lifestyle restrictions. It is estimated that migraines cost American employers $225.8 billion annually in lost work time and diminished productivity. Future research is needed on the comparative effectiveness of approved migraine drugs and in identifying potential treatment-modifying effects of patient age, sex, race, migraine family history, comorbidities, and prior treatment with migraine preventive drugs.
These findings and others can be found in the research review, Migraine in Adults: Preventive Pharmacologic Treatments at http://go.usa.gov/Tzd5.