Migraine Prophylaxis

Updated: July 26, 2022

Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

timolol

Initial:

Orally

every 12 hrs

Titrate to 10-30 mg per day

nadolol

off-label:

40 - 80

Tablet

Orally

once a day

and can be increased up to 240 mg orally per day

flunarizine

5 - 10

Orally 

once a day

Note: allow 2 consecutive medication-free days each week

pizotifen

0.5

Tablet

Oral

at bedtime

(increase up to 1.5 mg/day depending on tolerability)

erenumab

Solution

Subcutaneous (SC)

once a month

140 mg subcutaneous once a month may be required in some people (administered as 2 consecutive 70-mg subcutaneous doses)

cyproheptadine

Migraine Headache Prophylaxis :

Orally 

twice a day; w/wo propanol

fremanezumab

Indicated for the migraine preventive treatment:

225

Solution

Subcutaneous (SC)

once every month

Alternative: 3 consecutive 225mg subcutaneous dosages of 675 mg every three months (quarterly)

Dose Adjustments

Hepatic impairment
Dedicated studies on the effects of hepatic impairment on fremanezumab have yet to be performed. The data analysis from clinical studies indicated no differences in the pharmacokinetics in patients with mild liver dysfunction

Renal impairment
The pharmacokinetics are not anticipated to be affected, and no specific studies have been done to examine renal impairment

galcanezumab

Indicated for the preventive migraine treatment:

Initial dose: 240mg subcutaneous once a month
Maintenance dose: 120mg subcutaneously monthly once

rimegepant

75 mg orally every other day

amitriptyline

10 - 25

Orally 

at bedtime

10-400 mg Orally at bedtime dose range

pizotifen

For children >12 years: