Yes, it’s a great talk about drug options from a guy who really knows his stuff!
In summary:
Only about one-half of patients with migraine are correctly diagnosed; of those diagnosed incorrectly, 42% are diagnosed as having sinus-type headache and 32% as having tension-type headache; a survey showed that 94% of patients who sought treatment in physicians’ offices had migraine (migraine is a type of headache that gets severe enough for patients to seek treatment); although tension-type headache is most common in the population.
[size=150]Beta-blockers[/size]: all effective; propranolol most commonly used, but [size=140]speaker prefers atenolol[/size] (inexpensive; can be given once daily, typically at night; fewer side effects). In studies, 45% to 60% of patients reported 50% reduction in headaches.
[size=150]Calcium channel blockers[/size]: good for cluster headaches, [size=140]not good for migraine[/size] ; use doses higher than those for treatment of hypertension; may be effective if aura prominent feature; in studies, verapamil and amlodipine took up to 3 months to achieve effect.
[size=150]Tricyclic antidepressants[/size]: low doses effective (for amitriptyline, doxepin, and imipramine, 50 mg/day); with amitriptyline and doxepin, end point is sleep without daytime sedation; side effects with amitriptyline and doxepin include weight gain; with nortriptyline and imipramine, all side effects less; when using nortriptyline, prescribe by generic name, which costs about $17/month (brand name [Pamelor] costs $575/month!); desipramine and protriptyline nonsedating and not associated with weight gain (protriptyline currently available only by brand name [Vivactil])
[size=150]Other antidepressants[/size]: SSRIs and bupropion not effective in migraine; [size=140]venlafaxine (Effexor) effective[/size] ; in study, patients with anxiety benefitted from duloxetine; monoamine oxidase inhibitors effective, but have numerous side effects. Surprisingly, Cipramil (citalopram) did work for me although perhaps the SSRIs are more effective for vestibular migraine.
[size=150]Neural stabilizers[/size]: previously called anticonvulsants; divalproex (Depakote) and topiramate FDA-approved; both have significant side effects, including weight gain, hairloss, and fetal neural tube defects; in study, only 36% of patients responded to gabapentin.
[size=150]Alternative treatments[/size]: riboflavin—in small study, 59% of patients responded; magnesium—should be effective; known that patients with migraine have low levels of magnesium in brain; shown that intravenous magnesium stops headache; feverfew—effectiveness not clear; coenzyme Q10—effective in some studies; butterbur—in study, efficacy "71%, but efficacy of placebo 59%; botulinum toxin type A (Botox)—no clinical profile; anecdotally, some large trial now under way.
Best … Scott 8)