What is the most effective prophylactic medication for migraine headaches?
What is the most effective prophylactic medication for migraine headaches? Evidence-based answer: Propranolol, timolol, valproic acid, topiramate, and amitriptyline are FDA-approved and similarly effective for migraine prophylaxis when compared with placebo. Angiotensin-converting enzyme (ACE) inhibitors may be more effective than other treatments such as amitriptyline, anti-epileptics, and NSAIDs. Gabapentin is ineffective for preventing migraines (SOR: A, systematic reviews of RCTs). OnabotulinumtoxinA reduces the frequency of chronic migraine attacks but efficacy compared with other treatments is unknown (SOR: B, one RCT).
Evidence-Based Practice 19, no. 6 (2016): 6-7