Prevention of Acute Episodic Migraine

A guideline from the American College of Physicians organizes drug treatment options into 3 tiers.

Sponsoring Organization: American College of Physicians (ACP)

Background

The ACP has issued a clinical guideline addressing drug treatment for preventing episodic migraine headache (i.e., 1–14 headache days monthly) in nonpregnant adults. The authors note that their evidence review relied mostly on comparisons between active drug and placebo; few head-to-head comparisons between preventive treatments were identified.

Recommendations

The guideline includes the three formal recommendations listed below. The sequence of drug choice represents the authors' attempt to balance effectiveness, potential adverse effects, and costs; it is not intended as a rigid, inviolable hierarchy.

First-line recommended drugs are β-blockers (i.e., metoprolol or propra…

Reviewing Author

Allan S. Brett, MD

Disclosures

Nothing to disclose