
Contents
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Introduction Introduction
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Impact of Preventive Treatment Impact of Preventive Treatment
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Principles of Preventive Treatment Principles of Preventive Treatment
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General Principles for Instituting Preventive Therapy General Principles for Instituting Preventive Therapy
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Guidelines for Stopping Preventive Therapy Guidelines for Stopping Preventive Therapy
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Specific Migraine Preventive Agents Specific Migraine Preventive Agents
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ß-Adrenergic Blockers for the Prevention of Migraine ß-Adrenergic Blockers for the Prevention of Migraine
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Summary: Evidence for ß-blockers in the Prevention of Migraine[] Summary: Evidence for ß-blockers in the Prevention of Migraine[]
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Antidepressant Medication for Migraine Prevention Antidepressant Medication for Migraine Prevention
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Tricyclic Antidepressants Tricyclic Antidepressants
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Selective Serotonin and Norepinephrine Reuptake Inhibitors Selective Serotonin and Norepinephrine Reuptake Inhibitors
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Summary: Evidence for Antidepressants in the Prevention of Migraine[] Summary: Evidence for Antidepressants in the Prevention of Migraine[]
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Calcium Channel Antagonists for the Prevention of Migraine Calcium Channel Antagonists for the Prevention of Migraine
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Conclusions Conclusions
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Summary: Evidence for Calcium-Channel Blockers in the Prevention of Migraine[] Summary: Evidence for Calcium-Channel Blockers in the Prevention of Migraine[]
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Anti-epileptic Drugs for the Prevention of Migraine Anti-epileptic Drugs for the Prevention of Migraine
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Carbamazepine Carbamazepine
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Gabapentin Gabapentin
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Valproic Acid Valproic Acid
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Clinical Context Clinical Context
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Topiramate Topiramate
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Lamotrigine Lamotrigine
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Oxcarbazepine Oxcarbazepine
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Summary: Evidence for Anti-epileptic Drugs in the Prevention of Migraine[] Summary: Evidence for Anti-epileptic Drugs in the Prevention of Migraine[]
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Serotonin Antagonists Serotonin Antagonists
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Methysergide Methysergide
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Cyproheptadine Cyproheptadine
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Other Drugs for the Prevention of Migraine Other Drugs for the Prevention of Migraine
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Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists
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Summary: Evidence for ACE-Inhibitors/Antagonists in the Prevention of Migraine[] Summary: Evidence for ACE-Inhibitors/Antagonists in the Prevention of Migraine[]
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NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults
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Histamines/Antihistamines/Leukotriene Receptor Antagonists Histamines/Antihistamines/Leukotriene Receptor Antagonists
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Histamine Histamine
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Cyproheptadine Cyproheptadine
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Montelukast Montelukast
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Conclusions Conclusions
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Medicinal Herbs, Vitamins, and Other Interventions Medicinal Herbs, Vitamins, and Other Interventions
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Herbal Preparations, Vitamins, and Minerals Herbal Preparations, Vitamins, and Minerals
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Petasides hybridus (Butterbur) Petasides hybridus (Butterbur)
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Tanacetum parthenium (Feverfew) Tanacetum parthenium (Feverfew)
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Other Vitamins and Herbal Preparations Other Vitamins and Herbal Preparations
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Summary: Evidence for Medicinal Herbs and Vitamins in the Prevention of Migraine[] Summary: Evidence for Medicinal Herbs and Vitamins in the Prevention of Migraine[]
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Aspirin and Other NSAIDS Aspirin and Other NSAIDS
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Summary: Evidence for Aspirin and other NSAIDS in the Prevention of Migraine[] Summary: Evidence for Aspirin and other NSAIDS in the Prevention of Migraine[]
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New Preventive Medications New Preventive Medications
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CGRP Antibody Antagonists[] CGRP Antibody Antagonists[]
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Botulinum Toxin for Migraine Botulinum Toxin for Migraine
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Formulations of Botulinum Toxin Formulations of Botulinum Toxin
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Mechanism of Action of Botulinum Toxin in Headache Mechanism of Action of Botulinum Toxin in Headache
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BoNT Treatment Techniques BoNT Treatment Techniques
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Clinical Studies of BoNT’s Efficacy in Headache Disorders Clinical Studies of BoNT’s Efficacy in Headache Disorders
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The PREEMPT Trials The PREEMPT Trials
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Adverse Events Associated with the Use of BoNT Adverse Events Associated with the Use of BoNT
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Conclusion Conclusion
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Appendix 1: AAN Classification of Evidence for the Rating of a Therapeutic Study Appendix 1: AAN Classification of Evidence for the Rating of a Therapeutic Study
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Appendix 2: Classification of Recommendations Appendix 2: Classification of Recommendations
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References References
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8 Preventive Treatment
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Published:March 2016
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Abstract
Preventive therapy is used to reduce the frequency, duration, or severity of migraine attacks. Benefits may include the enhancement of response to acute treatments; improvement in function; and the reduction of disability. Prevention is used when (1) migraine attacks significantly interfere with a patient’s quality of life despite appropriate use of acute medications; (2) the patient has frequent headaches (≥ 4 attacks/month or ≥ 8 headache days a month); (3) failure of, contraindication to, overuse, or troublesome side effects from acute medications; (4) patient preference; and (5) hemiplegic migraine; basilar migraine; frequent, prolonged or uncomfortable aura symptoms; or a history of migrainous infarction.
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