Video Q & A:

Prevention 101


What off-label use of drugs can help prevent migraine?

Expert:   Joshua Cohen, M.D., M.P.H. , St. Luke’s-Roosevelt Hospital Center »

Your doctor can prescribe a variety of drugs that help ease the pain of a migraine attack. And some of them may be off-label. Watch this to see what they are!

Transcript: Your doctor can prescribe a variety of drugs that help ease the pain of a migraine attack. But, the Food and Drug Administration has approved only five specific medications for PREVENTION of migraine: propanolol and timolol are BETA-BLOCKERS, divalproex sodium and topiramate are ANTICONVULSANTS, and Botox, popularly known as an anti-wrinkle treatment. But don’t fret if you’re not on one of these medications. Several other preventive drugs and vitamins were OK’d by the FDA for OTHER purposes, and have been found to ALSO be effective in migraine prevention. If your doctor prescribes these drugs for your migraine headaches, he is using them OFF-LABEL – which means that it’s perfectly legal for them to be prescribed, the meds are just not allowed to be advertised for that purpose. Let’s talk about medications originally used to lower blood pressure and treat heart disease. When used to treat migraine, beta blockers calm the overexcited nerves in the brain and calcium blockers reduce inflammation that is associated with migraine. While TWO beta blockers have already been approved for migraine prevention, three others, metoprolol, nadolol and atenolol , have also been shown to be successful in research trials. Calcium channel blockers are not FDA approved for migraine, but over 45 research studies reported that they’re effective. Of the several drugs in this class of medication, VERAPAMIL is the first choice among doctors. Nimodipine, nifedipine, cyclandelate and nicardipine are also useful. Just as with beta and calcium channel blockers, the method in which ANTICONVULSANTS prevent migraines isn’t exactly known. It’s possible that they calm the over-excited nerves in the brain that trigger a headache. While two anticonvulsants have been FDA-approved, two others pregabalin and leviteracetam.are also prescribed to avert migraine headaches. ANTIDEPRESSANTS are another major class of drugs that help a person dodge migraine attacks. They likely help by regulating the levels of serotonin in the brain. While doctors prescribe several types for this purpose, so far the MOST effective are tricyclic antidepressants. If you prefer to take a more natural route for migraine prevention, you have several choices. Doctors often suggest taking Vitamin B2 supplements. Many studies show that this vitamin, also known as riboflavin, is instrumental in cutting down migraine frequency. Magnesium is also useful for many people seeking to reduce the number of their attacks. Clinical trials have shown that the mineral is effective. You can also ask your doctor about the vitamin substance conenzyme Q10 and the herb called butterbur. Head to your doctor to discuss your off-label drug options. More »

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