Migraine prevention treatments, which can have a variety of
adverse side effects, should be administered for more than 6 to 12 months to
achieve the best results, an expert opinion and review of the literature
suggests.
Even though the current recommendation for treatment length
is 3-6 months, research has shown that more time is better: in one study 76% of
patients who continued treatment for 24 months were pain-free for the next
three years (without treatment), whereas only 44% of patients who continued
treatment for 12 months remained pain-free. However, the side effects of
certain treatments might be very severe, researchers said…
"Despite the availability of multiple evidence-based
guidelines providing recommendations on migraine preventive treatment options,
research suggests that approximately 40% of migraine sufferers would benefit
from preventive therapies, while only 13% receive them," they explained.
"The majority of patients will need long term
medications for the prevention of migraine, thus it is crucial for physicians
to be aware of adverse effects due to long term exposure to the
medications," said Starling in an email to MedPage Today…
Topiramate, a migraine prevention treatment with level A
evidence supporting its use against headaches, was tested by researchers. They
found that discontinuing treatment after six months leads to withdrawal
consisting of worsening headaches, while continuing the treatment beyond six
months leads to fewer and less severe headaches.
Those who experienced adverse withdrawal symptoms at the
6-month mark were put back on the drug. Discontinuation was attempted a second
time after another 6 months had passed and patients again experienced worsening
of headaches, suggesting that a prophylaxis period longer than 12 months is
most likely necessary for these patients….
Valproate products, like topiramate have level A evidence to
back their treatment for migraines.
Researchers claim that divalproex sodium (one valproate
product) was effective as a long-term treatment option, but that side effects were
likely to occur early on, and [headaches?]were likely to worsen if patients
discontinued treatment prior to completing its optimal duration…
Amitriptyline, an antidepressant medication, only has level
B support for migraine prevention. In a study, patients' likelihood of going
into remission increased if they had been taking the treatment for a longer
period of time…
Like amitriptyline, venlafaxine is an antidepressant and
also received level B support for the purposes of the current review. However,
its adverse effects have only been observed for the treatment of anxiety and
depression, and not for the prevention of migraines.
Propranolol is a beta-blocker with level A evidence in
support of its treatment in preventing migraines. In one trial, researchers
found that patients discontinued taking the medication early on due to the
onset of harmful side effects. These included but were not limited to
dizziness, diarrhea, and insomnia.
This treatment [OnabotulinumtoxinA] is "the only
FDA-approved treatment for chronic migraine based on the PREEMPT trials,"
said the authors who also explained that this treatment is given through
series' of injections.
This was the only treatment out of the ones analyzed that
did not seem to cause worse migraines when termination occurred within the
first 6 to 12 months, according to the article.
VanderPluym J, Evans RW, Starling AJ. Long-Term Use and
Safety of Migraine
Preventive Medications. Headache. 2016 Aug 1. doi:
10.1111/head.12891. [Epub
ahead of print] PubMed PMID: 27477594.
Abstract
Migraine preventive medications are used to reduce the
frequency, severity, and disability of migraine attacks. Once migraine
preventive therapy is initiated, the question of how long to maintain this
therapy arises. This article will explore the literature pertaining to the
long-term use of migraine preventive medications, including length of treatment
and safety with long-term exposure.
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