MONDAY, April 29 (HealthDay News) -- People with severe or
frequent migraines often turn to drugs to prevent them. But do the
A new review of preventive treatments shows there is not much
difference in the effectiveness of commonly prescribed drugs --
they work for some people, in some cases. But there is wide
variation in the amount and severity of side effects associated
with the drugs.
The researchers found that drugs worked better than inactive
placebos in reducing monthly migraine attacks. They prevented half
or more migraines in 200 to 400 people per 1,000 treated. But many
of the medications had side effects so bothersome that sufferers
frequently stopped taking them.
That could be because none of the drugs used to prevent
migraines was designed specifically for that purpose, explained Dr.
Jason Rosenberg, director of the Johns Hopkins Headache Center.
"So, it's not surprising that they don't work all that well. Only
one-third get halfway better, according to the study, so a doctor
has to treat three people to get one patient better."
Rosenberg, who was not involved with the study, suffers from
migraines and thinks many primary care doctors may be less aware of
the side effects of the drugs used to prevent migraines than are
headache specialists. So, they may not warn patients about the
potential problems and frequently don't follow up to see how the
patients are doing, he added.
The side effects are typically no fun, said Rosenberg. "A number
are badly tolerated. Some cause weight gain, hair loss, can cause
birth defects [one drug], some tingling, sleepiness, impaired
ability to exercise, an increased risk of diabetes and sexual side
effects," he noted. Some problems, such as kidney stones, are only
detected with long-term follow-up, he added.
That's why physicians and patients need better information, said
review author Dr. Tatyana Shamliyan, a researcher at the Minnesota
Evidence-Based Practice Center in Minneapolis. Good research
clearly shows potential benefits and harms, and "helps a great deal
in making informed decisions," she said.
But finding information about the options and downsides can be
Rosenberg said that before Shamliyan's study, no one had done a
thorough, comprehensive review of the side effects of medications
used to prevent migraines. "They've done a Herculean task," he
Both the American Academy of Neurology and the American Headache
Society have issued guidelines that recommend two types of
anti-epileptic drugs and two beta blockers for prevention of
migraines in adults. But neither medical group considered the value
of balancing the effectiveness against the side effects, Shamliyan
Migraines affect about 12 percent of the U.S. population, and
involve throbbing or pulsing head pain, often associated with
sensitivity to light and sound, according to the U.S. National
Library of Medicine.
The new research was published online in the April issue of the
Journal of General Internal Medicine. Out of an initial
group of more than 5,000 studies related to preventing migraines,
the researchers found 215 publications that involved randomized
clinical trials -- considered the gold standard in research -- and
76 publications of non-randomized studies. The researchers reported
that most trials were funded by industry and did not disclose
conflicts of interest by study investigators.
Most of the studies were conducted in the United States and
Western countries, and enrolled mostly middle-aged women with
episodic migraines. Participants were mostly overweight and had an
average of five migraine attacks a month. Shamliyan noted that many
of the studies failed to control for key factors, such as the
severity of the headaches, the presence of other health conditions
in those studied, other migraine treatments being used, family
history, and social and economic status.
Based on their analysis of the studies, the researchers
concluded that approved drugs and off-label angiotensin-inhibiting
drugs (lisinopril, captopril and candesartan), or off-label beta
blockers (metoprolol, acebutolol, atenolol and nadolol) were
effective in preventing episodic migraines in adults.
Off-label angiotensin-inhibiting drugs showed the most favorable
combination of benefits to potential harms. The U.S. Food and Drug
Administration permits physicians to prescribe approved medications
for purposes other than their intended indications, and that
practice is known as off-label use.
The study also found that there's a lack of research available
about the long-term effects of drug treatments, especially on
quality of life.
In treating migraines, off-label medications are frequently
used, said Rosenberg. "In my practice I'm prescribing off-label as
much as on-label." This, while state-of-the-art, should be a call
to action, he added. "It's totally unacceptable that all the drugs
we're using were invented for other diseases."
Learn more about migraines from the
U.S. National Library of Medicine.
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