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Preventative migraine therapies
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People who suffer from frequent or severe migraines often are left to turn to prescription or over-the-counter medications to battle the pain. Depending on what you take for your migraine, the results can range from highly effective to nearly ineffective, something only you can determine often through multiple trial-and-error approaches. Once you do actually find a medication that works, using it too often can lead to problems. Overuse of any migraine remedy actually can make headaches worse by making them more frequent and more painful, a problem known as “medication-overuse headaches.” Still, while a medication might be the go-to remedy for a migraine, there’s no denying that it is a reactive approach. For a more proactive approach, migraine sufferers should consider preventative migraine therapies.

Blount Memorial Hospital pharmacist Barbara Kahn says preventative therapies are best suited to specific migraine patients. “Patients who suffer from migraines two or three times per month, or who have two or more days of debilitating migraines, should at least consider preventative therapies,” Kahn said. “Several classes of drugs are being used for migraine prevention, including beta-blockers, tricyclic antidepressants, anticonvulsants, calcium channel blockers and ACE inhibitors. Some of these may reduce intensity and frequency of migraine headaches by half or more for up to 65 percent of patients,” she explained. “The latest guidelines, however, recommend avoiding SSRI antidepressants, gabapentin, verapamil and lamotrigine because the evidence on their effectiveness is lacking or, in some cases, conflicting,” she added.

There are, however, more natural preventative migraine therapies. “The latest guidelines also are suggesting natural medicines as preventative options,” Kahn said. “These often are used in combination with conventional treatments. Some of the options include butterbur, feverfew, magnesium and coenzyme Q10. A specific butterbur rhizome extract such as Petadolex, seems to reduce the frequency, intensity and duration of migraine headaches when used for a period of four months. Patients who try it should take at least 75 mg twice per day. The long-term safety of butterbur is unknown and some products can contain alkaloids, which are carcinogenic and can cause liver and kidney damage,” she added.

“Feverfew is the most well-known natural medicine used to prevent migraines,” Kahn explained. “This typically is taken in doses of 50 to 100 mg per day of the extract. Most evidence suggests feverfew can reduce the frequency of migraines, but there is not as much evidence that it is effective for treating a severe acute migraine attack. It also is not appropriate for patients with allergies to ragweed or related plants, as feverfew is in the same family and could cause a cross-sensitivity reaction,” she said. “Also, patients who have taken feverfew for extended periods of time should taper the dose, and not stop taking it abruptly. There are reports of a ‘post-feverfew syndrome’ in patients who abruptly stop taking feverfew after extended use, which can include symptoms such as nervousness, headache, insomnia, joint pain and tiredness,” she added.

While magnesium has been used to treat migraines, Kahn says it also can be used in migraine prevention. “Magnesium usually is safe when used in doses below the tolerable upper intake level of 350 mg per day for adults and children over age eight,” she said. “Remember to avoid taking magnesium if you have kidney or heart disease unless you check with your doctor first,” she added.

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