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Drugs Can Sometimes Prevent Migraines, at a Cost

Study finds many have side effects so bothersome that sufferers stop taking them
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But finding information about the options and downsides can be difficult.

Rosenberg said that before Shamliyan's study, no one had done a thorough, comprehensive review of the side effects of medications used to prevent migraines. "They've done a Herculean task," he said.

Both the American Academy of Neurology and the American Headache Society have issued guidelines that recommend two types of anti-epileptic drugs and two beta blockers for prevention of migraines in adults. But neither medical group considered the value of balancing the effectiveness against the side effects, Shamliyan said.

Migraines affect about 12 percent of the U.S. population, and involve throbbing or pulsing head pain, often associated with sensitivity to light and sound, according to the U.S. National Library of Medicine.

The new research was published online in the April issue of the Journal of General Internal Medicine. Out of an initial group of more than 5,000 studies related to preventing migraines, the researchers found 215 publications that involved randomized clinical trials -- considered the gold standard in research -- and 76 publications of non-randomized studies. The researchers reported that most trials were funded by industry and did not disclose conflicts of interest by study investigators.

Most of the studies were conducted in the United States and Western countries, and enrolled mostly middle-aged women with episodic migraines. Participants were mostly overweight and had an average of five migraine attacks a month. Shamliyan noted that many of the studies failed to control for key factors, such as the severity of the headaches, the presence of other health conditions in those studied, other migraine treatments being used, family history, and social and economic status.

Based on their analysis of the studies, the researchers concluded that approved drugs and off-label angiotensin-inhibiting drugs (lisinopril, captopril and candesartan), or off-label beta blockers (metoprolol, acebutolol, atenolol and nadolol) were effective in preventing episodic migraines in adults.

Off-label angiotensin-inhibiting drugs showed the most favorable combination of benefits to potential harms. The U.S. Food and Drug Administration permits physicians to prescribe approved medications for purposes other than their intended indications, and that practice is known as off-label use.

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