Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: [RETIRED]

Abstract

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: Are nonsteroidal anti-inflammatory drugs (NSAIDs) or other complementary treatments effective for migraine prevention? Methods:The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention. Results:The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein.Recommendations: Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A). Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B). Treatments considered possibly effective are cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen (Level C). Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega-3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B). Epidemiologic studies suggest approximately 38% of migraineurs need preventive therapy, but only 3%-13% currently use it.1 In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention.2,3 Since then, new clinical studies have been published on the efficacy and safety of migraine preventive therapies. This guideline seeks to assess this new evidence to answer the following clinical question: For patients with migraine, which anti-inflammatory or complementary treatments are effective for prevention, as measured by reduced migraine attack frequency, reduced number of migraine days, or reduced attack severity? This article addresses the efficacy and safety of histamines/antihistamines; nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics; and several herbal, vitamin, and mineral preparations, whereas a companion article addresses standard pharmacologic treatments for migraine prevention.

Complementary and Integrative Medicine for Neurologic Conditions

“…Table 2 lists the supplements with American Academy of Neurology (AAN) level A–C evidence (A-strongest; C-least strong) for use in the prevention of episodic migraine. 23 MIG-99 (an extract of the herb feverfew [ Tanacetum parthenium ]), magnesium, and riboflavin (vitamin B2) have level B evidence for migraine prevention, and Coenzyme Q10 has level C evidence. Although Petasites hybridus (butterbur) was categorized as level A, recent concerns over hepatotoxicity have limited recommendations for its use so it is not included in the table.…”

“… * AAN Guidelines (A-strongest evidence; C-least strong evidence) 23 ** If problems with diarrhea while on magnesium citrate, magnesium glycinate formulation may be better tolerated …”

Prophylaxis of Migraine in Children and Adolescents

“…The AAN guidelines state that magnesium is probably effective for adult migraine prophylaxis on the basis of Level B evidence [48]. Evidence, however, remains limited in children.…”

Cluster Headache

“…Subcutaneous administration of histamine has Level B evidence in the most recent migraine guidelines. 111 The mechanism of action is unknown, but may relate to downregulation of the cGMP-NO-L-arginine pathway and subsequent effects on CGRP and other vasoactive peptides associated with cluster headache. 112,113 …”