Pharmacological Migraine Prophylaxis Guidelines

Selecting a therapy:¹⁻³ Initial selection of agents should be based on the level of established efficacy. Routinely evaluate patient response and utilize factors such as comorbidities, personal considerations, and adverse reactions to guide and individualize therapy. Comparisons of efficacy amongst agents of the same drug class for short-term as well as chronic use have not been established by the evidence currently available.

Frequent or high dosing of these medications can lead to rebound headaches and progression to chronic headache disorders. Initiate at the lowest possible dose then increase to desired effect or development of an adverse reaction. An adequate trial length is between 2−6mos. Discontinuation via a taper is encouraged if a patient is well-controlled after 6−12mos of therapy.