Best Drugs for Preventing Chronic Migraine: New vs. Traditional Treatments

For individuals experiencing chronic migraines (defined as headaches on 15 or more days per month), finding an effective prescription medication is crucial for managing their condition. Recent research has evaluated the efficacy of various drugs in preventing migraine attacks and offers new insights into treatment options.

Effectiveness of Preventive Medications

Recent analysis of multiple studies reveals that all tested drugs significantly reduce the frequency of headache days and migraine attacks. However, newer medications, such as eptinezumab and erenumab, have shown greater effectiveness compared to traditional drugs like topiramate. While traditional medications are generally less expensive, they tend to be associated with more adverse events.

Newer vs. Traditional Drugs

Newer Drugs

Newer treatments, including eptinezumab, erenumab, fremanezumab, and galcanezumab, typically administered via monthly injections, have been found to be more effective. They are generally recommended for patients who have not responded to at least three prior treatments. Research has shown:

• Eptinezumab 300mg is the most effective, reducing headache days by 2.5 per month more than placebo.
• Fremanezumab is the most effective for reducing migraine attack days, with a reduction of 2.8 days per month compared to placebo.

Traditional Drugs

Traditional drugs like topiramate are less effective but more affordable. The study highlights:

• Topiramate 100mg was the least effective, reducing headache days by only 1.1 per month more than placebo and migraine attacks by 1.5 days per month.

Adverse Events and Cost Considerations

The analysis also revealed that traditional drugs such as amitriptyline and topiramate were associated with more adverse events, particularly affecting the nervous system. Newer treatments generally had fewer side effects. Despite being more expensive, eptinezumab provided the most significant improvement in quality of life.

Study Limitations and Future Directions

The research, which reviewed 12 trials involving 7,909 participants, compared various drugs against placebo rather than directly against one another. This limitation means that while the data provides valuable insights, comparisons between different drugs should be made cautiously. Additionally, the effectiveness of other commonly used preventive drugs like amitriptyline and propranolol was not covered due to evidence constraints.

What’s Next?

Further research is needed to evaluate the cost-effectiveness and safety of traditional versus newer preventive drugs. There is also a call for studies comparing specific treatments, such as calcitonin gene-related peptide monoclonal antibodies and botulinum toxin A, as well as other drugs like candesartan and flunarizine.

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