Migraine prophylaxis: less evidenced options
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Migraine prophylaxis: less evidenced options. Lisinopril: 20mg daily, Atogepant: a CGRP-receptor antagonist. Fully referenced neurology checklist.
Less evidenced agents
- Lisinopril: 20mg daily
- Atogepant: a CGRP-receptor antagonist
- Magnesium: 400-600mg daily
- Melatonin: 2mg daily: maintenance is 4-8mg daily
- Memantine 10-20mg daily
- Nortriptyline: the starting dose is 10mg daily: increase by 10mg weekly to 25-75mg nocte
- Riboflavin: 400mg daily
- Cyproheptadine: 4-12mg daily
- Venlafaxine: starting dose is 37.5mg daily: aim for 75-150mg daily
- Clonidine
- Guanfacine
- Methysergide
- Nebivolol
- Pindolol
Insufficient evidenced agents
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Investigational agents
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Acronym
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References
- Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514.
- Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012; 78:1337-1345.
- MacGregor EA, Steiner TJ, Davies PTG. British Association for the Study of Headaches (BASH). Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. September 2010.
- Sprenger T, Viana M, Tassorelli C. Current prophylactic medications for migraine and their potential mechanisms of action. Neurotherapeutics 2018; 15:313-323.
- Hovaguimian A, Roth J. Management of chronic migraine. BMJ 2022; 379:e067670.
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