Drug safety and tolerability in prophylactic migraine treatment

Abstract

The background of the recurrence and chronification of migraine attacks has not been fully clarified, and causative preventive therapy is therefore not currently available. The tolerability and adverse effects of the currently used medications often limit their use. β-Adrenergic receptor blockers may induce adverse cardiovascular events, whereas flunarizine is frequently associated with a weight gain and depression. As most migraine sufferers are young women of child-bearing age, the use of valproate is limited. Topiramate is associated with central nervous system-related side effects. There is a need for future development of pathomechanism-based preventive drugs, and personalized therapy tailored to the patient.

A Review of Monoclonal Antibody Therapies and Other Preventative Treatments in Migraine

“…However, none were specifically developed for the treatment of migraine, and their mechanism of action in preventing migraine is unclear. The use of oral preventive therapy is limited in some cases by tachyphylaxis, and more commonly by poor tolerability, with common side effects including weight gain, fatigue, depression, mood changes, cognitive slowing, and gastrointestinal symptoms (Table ) . Among the predominantly young and female migraine population, weight gain and sedation are of particular concern .…”

Long‐Term Use and Safety of Migraine Preventive Medications

“…Furthermore, they also had significant elevations in mean diastolic blood pressure and mean change in heart rate from baseline to final visit . Caution is required for its use in patients with angle‐closure glaucoma, urinary retention, and prostatic hypertrophy . Also amitriptyline has a pregnancy category C designation by the FDA…”

“…38 Caution is required for its use in patients with angle-closure glaucoma, urinary retention, and prostatic hypertrophy. 39 Also amitriptyline has a pregnancy category C designation by the FDA. 40 Tricyclic antidepressants have been associated with heart block, ventricular arrhythmias, and sudden death.…”

Evaluation of propranolol, flunarizine and divalproex sodium in prophylaxis of migraine

“…[10][11][12] A preventive drug should be chosen based on its proven efficacy, the patient's preferences and headache profile, the drug's side effects, and the presence of any coexisting disease. The updated 2012 guidelines from the American Academy of Neurology (AAN) and the American Headache Society (AHS) classify preventive agents on 4 levels: [13][14][15] • Level A include drugs with established efficacy, for e.g. ; beta-blockers, calcium channel blockers and antiepileptics • Level B include drugs with probable efficacy, for e.g.…”

“…22 These findings are coinciding with the result of various studies comparing the efficacy and safety of drugs in prophylaxis of migraine. 14,21 Most of the patients recovered from the ADRs despite without any intervention.…”