Evidence-Based Migraine Prevention

Drove around town this morning making house calls (so what else is new?).  Met my patient suffering from migraines who preferred the fast disintegrating form of her triptan compared to the standard tablet but her insurance company refused to pay w/o prior authorization.  I had completed the paperwork last week explaining that she'd failed other remedies.  The suits shot back that they wanted names & dates of all the meds that she'd failed!  Isn't it amazing the roadblocks they'll throw in front of us in the name of saving money?  Let's not even go into the waste of my time & effort.

Any way, we were talking about her migraines today when she reported that she was suffering from them almost daily.  I asked about taking something daily for prevention rather than trying to relieve pain after the fact.  Turns out she also has high blood pressure which means she'd be an excellent candidate for a beta blocker, perhaps even a non-dihydropyridine calcium channel blocker, taken daily as prophylaxis.

Serendipitously, two evidence-based guidelines were published online today in Neurology reviewing migraine prophylaxis options, both pharmacologic as well as OTC NSAIDs.  So if you're suffering from frequent and/or severe migraines, think about preventing a forest fire rather than just putting out the fire.  And ask your physician about your options.

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