The newest guidelines for preventing migraines focus on prescription drugs, and tout the efficacy of several non-prescription and herbal options in fighting the debilitating headaches.
"Studies show that migraine is under-recognized and under-treated,” guideline author Dr. Stephen Silberstein of Jefferson Headache Center at Thomas Jefferson University in Philadelphia said in a statement. “About 38 percent of people who suffer from migraine could benefit from preventive treatments, but only less than a third of these people currently use them.”
More than 35 million people in the U.S. experience migraine headaches and estimates suggest they cost more than $20 billion each year, both in direct medical costs and loss of productivity.
The new guidelines, co-developed by the American Academy of Neurology which will publish them Tuesday, and the American Headache Society, found that several seizure drugs, including divalproex sodium, sodium valproate and topiramate, can be effective at curbing the frequency of migraines, as well as the severity of their attacks.
Many beta-blockers, which block the effects of adrenaline and help blood flow, were found to be effective at prevention -- among them, metoprolol, propranolol and propranolol.
But the new guidelines also looked at the role that non-prescription options can play in staving off migraines. Non-steroidal anti-inflammatories, which include ibuprofen, were found to be effective in preventing migraines, while magnesium, an extract of feverfew (a bush with daisy-like flowers) and riboflavin or vitamin B2 were all deemed "probably" effective.
In addition, petasites, an extract from the butterbur plant, was found to be effective in cutting the number of migraine attacks by up to 48 percent in some studies. The authors caution, however, that the safety of long-term use of the extract is undetermined and stress that even non-prescription treatments should be taken in consultation with a health-care practitioner.
"I'm very excited that butterbur gets the same rating based on the strong science (reviewed) as some of the prescription drugs," said Dr. Richard Lipton, director of the Montefiore Headache Center who led one of the studies that the guideline's authors considered. "Many headache specialists already use it. But for many physicians who don't focus on headaches, the guidelines will help underline the science."
Indeed, experts agree that one of the practical outcomes of the new guidelines is that health care providers who do not specialize in neurology, but who often end up treating patients for migraine, now have clear-cut recommendations. The guidelines help distill the broad body of scientific literature available.
"These sorts of guidelines are very important and they are based on a lot of hard work," said Dr. Michael Cutrer, chair of the headache division in the Mayo Clinic's department of neurology. "However, while they are a good starting point, we need to realize that they have many limitations"
The new guidelines, Cutrer said, also are based on recent studies and thus might reflect a publication bias toward newer treatment options. In addition, research suggests that the mechanisms underlying migraine might differ significantly, so what works for one person may not work for another.
Another issue, according to Cutrer, is that the new guidelines are based on the probability that treatments will be successful, and not how well individuals react to and cope with possible side effects.
"In guidelines like this, the main variable that they're assessing is the relative efficacy in trials. But what's probably equally important is whether or not the person is going to be tolerant of the drug," he said. "Some of the ones that perform very highly also have fairly high side effects."