“…the 2012 AHS/AAN guidelines assign treatments to Levels based on assessment of the strength and quality of evidence of efficacy. Adverse effects, contraindications to use and other clinical considerations are reviewed but are not incorporated in the assignment of drugs to a particular level.” American Headache Society’s Journal

American Headache Society and the American Academy of Neurology joined forces to establish guidelines to assist health care professionals in choosing treatments for episodic Migraine prevention. Both societies issued these guidelines through their journals.

The Guidelines

The guidelines list medications in different levels. Below is a summary of each level, what the levels mean, and the medications assigned to those levels:

Level A: Established as effective
Should be offered to patients requiring Migraine prevention:

  • divalproex/sodium valproate
  • metoprolol
  • petasites (butterbur)
  • propranolol
  • timolol
  • topiramate

Level B: Probably effective
Should be considered for patients requiring Migraine prevention:

  • amitriptyline
  • fenoprofen
  • feverew
  • histamine
  • ibuprofen
  • ketoprofen
  • magnesium
  • naproxen/naproxen sodium
  • riboflavin
  • venlafaxine

Level C: Possibly effective
May be considered for patients requiring Migraine prevention:

  • candesartan
  • carbamazepine
  • clonidine
  • granfacine
  • lisinopril
  • nebivolol
  • pindolol
  • flurbiprovin
  • mefanamic acid
  • Coenzyme Q10
  • cyproheptadine

The guidelines also included medications recommended for short-term prevention of menstrually triggered Migraines:

Level A: Established as effective:
Should be offered to patients requiring prevention:

  • frovatriptan (Frova)

Level B: Probably effective:
Should be considered for patients requiring prevention:

  • naratriptan (Amerge, Naramig)
  • zolmitriptan (Zomig)

Level C: Possibly effective
May be considered for patients requiring prevention:

  • estrogen

A third section of the guidelines consists of medications and treatments where we have either inadequate evidence that they’re effective or where there’s evidence that they’re not effective. It’s important to note here that this does NOT mean that these medications don’t work for anyone. There will undoubtedly be some responses to these guidelines – and remember that they are just that – guidelines.

Level U: Conflicting or inadequate evidence
insufficient data to support or refute using for Migraine prevention:

  • acenocoumarol
  • acetazolamide (Diamox)
  • aspirin
  • bisoprolol
  • Coumadin
  • cyclandelate
  • fluoxetine
  • fluvoxamine
  • gabapentin (Neurontin)
  • hyperbaric oxygen
  • indomethacin (Indocin)
  • nicardipine
  • nifedipine
  • nimodipine
  • Omega-3
  • picotamide
  • protriptyline
  • verapamil

Medications or treatments established as possibly or probably ineffective for Migraine prevention
Should not be offered or considered for Migraine prevention:

  • acebutolol
  • clomipramine
  • clonazepam
  • lamotrigine
  • montelukast
  • mabumetone
  • oxcarbazepine
  • telmisartan