Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults

Neurology®, 04/25/2012

Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega–3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B).

Methods

  • The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention.

Results

  • The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein.
  • Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A).
  • Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG–99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B).
  • Treatments considered possibly effective are cyproheptadine, Co–Q10, estrogen, mefenamic acid, and flurbiprofen (Level C).

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