Combination Therapy for Chronic Migraine

Adding propranolol to topiramate is unlikely to provide a clinically relevant benefit to patients who have inadequate relief on topiramate monotherapy.

Chronic migraine (CM) is a disabling condition that only recently has gained separate classification status from episodic migraine. The evidence-based treatment options for CM are limited to topiramate and onabotulinumtoxinA. Clinicians often see patients with inadequately managed CM. Data from uncontrolled studies in refractory migraine suggest that combination therapy, including a neuromodulator (e.g., topiramate or valproate) and a beta-blocker may be beneficial because of a presumed synergistic effect. To test this theory, researchers conducted a double-blind, placebo-controlled clinical trial, randomizing patients whose CM was inadequately controlled with topiramate (50–100 mg/day) to add either long-acting propranolol (up to 240 mg/da…

Reviewing Author

Koen Paemeleire, MD, PhD