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Verapamil Migraine Prevention

verapamil migraine prevention

Prevention of Migraine

Patients with frequent or severe migraine headaches and those who cannot take vasoconstrictors or are refractory to acute treatment should receive preventive treatment.1,2 Menstrual migraine attacks may sometimes be prevented by a brief course of an NSAID or triptan, particularly frovatriptan or naratriptan, taken for several days before and after the onset of menstruation.3,4 Preventive therapy is generally not recommended during pregnancy.

Prophylaxis in general

Australian Therapeutic Guidelines recommend regular preventive treatment for patients who continue to experience more than two or three acute attacks of migraine per month.5 Other experts highlight that prophylaxis may be warranted in some patients with a lower attack frequency if they have prolonged or disabling attacks.6 Patient preference should, of course, always be considered.

Influential evidence-based reviews of migraine treatment have been published by both the American Academy of Neurology7 and the European Federation of Neurological Societies.8 Although there are many prophylactic agents with established efficacy, Australian general practitioners restrict their choice, in most cases, to pizotifen or propranolol.

Guidelines for success in prevention

It is important that the physician and patient have reasonable goals for treatment and define success appropriately (Table 1). It is not reasonable for the physician to expect or promise freedom from headache. Reduction in overall disability and improvement in quality of life are the primary goals.

The patient should be informed of the most common side effects of the medication in a clear and supportive manner so that when the side effects occur, the patient will not discontinue the medication. The physician and patient should recognize that pharmacologic treatments frequently involve trade-offs, and some side effects may be acceptable givøen the reduction in disability.

Do you need migraine prevention?

Migraine patients do not want to suffer from an attack, so prevention is important even if they suffer from only one attack a year. Those who suffer from frequent attacks will need more aggressive prevention strategies that sometimes include medication. This decision is made by discussing treatment and management options with your physician. Additionally, nonpharmacological prevention may help if you have:

Disabling attacks despite appropriate acute treatment

Frequent attacks (>1 per week).

Insufficient or no response to acute drug treatment.

Poor tolerance or contraindications for specific acute pharmacological treatments.

History of long-term, frequent, or excessive use of pain medications (analgesics) or acute medications that make headaches worse (or lead to decreased responsiveness to other drug therapies).

Patient preference.

Which Treatment is right for you?

When deciding on preventive therapies, it is important to review with your doctor several important management principles:

Ask your physician what you can expect from the medication regarding its efficacy. In other words, as “What is the benefit likely to be for me when I take this medication?“

Low doses are used at first and gradually increased to higher doses as needed. Therefore, you may need to increase medication dose until the desired response is achieved.

Lower dosing frequency is often convenient, however, some medications may need to be taken twice or even three or four times a day. Discuss the dosing frequency of the medications and make sure the plan is convenient and easy to follow. Otherwise, you may not take the medication as prescribed and the efficacy benefits may not be achieved.

It may take two to three months before you notice a decrease in the frequency or severity of attacks even after reaching “the beneficial dose.”

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