Chronic Migraine Medications
| Medication | Dose range | Labs / monitor | Side effects |
| Propranolol | 120-240mg/day | Monitor BP, glucose | Cough, GI pain, chest pain, dry mouth, anxiety |
| Topiramate |
Start 15-25 mg/hs; increase to max of 200mg/day in divided doses
25 mg tablets take 1 tablet at night Day 7: take 1 in the AM and 1 in the PM Day 14: take 1 in the AM, 2 in the PM Day 21: take 2 in the AM, 2 in the PM MAX: 200 mg If symptoms stop with any prophylactic meds u can stop them but u may not be able to |
Monitor bicarb levels b/c it can lower them
Migraine preventative |
Side effects: cognitive difficulties, sedation, fatigue, kidney stones, weight loss
Can cause acute glaucoma (IF THIS HAPPENS STOP THE MED!) |
| Divalproex/sodium valproate | 250mg 2xday; 500-1000mg/day | Blood and Liver function tests | This is better tolerated than Valproic Acid, Birth defects, liver dysfunction, pancreatitis, dizzy night headed, vision change, loss of memory |
| Amitriptyline | 25-150 mg/day | Do not take if have you have problems with liver, kidney, heart, seizures, pregnant glaucoma or diabetes. Do not take with opioids or St John’s wort. | Irregular heart beat, yellow skin, eye pain or swelling, confused (low sodium), dry mouth dizziness difficulty peeing |
| Atenolol | 100mg/day (50-200mg) | Do not take if have bradycardia, diabetes, thyroid dysfunction, hypoglycemia, kidney or lung disease | Blurred vision, confusion, dizziness |
| Erenumab (Monoclonal antibodies) | Self-inject once a month 70 mg or 140 mg SC | Only preventative |
Side effects: constipation, injection site Warning: HTN Not recommended in pregnant patients (must have 6 months free of antibodies before getting pregnant) |
| Galcanezumab (Monoclonal antibodies) |
Loading dose 240 mg SC; followed by monthly injections of 120 mg SC
For episodic cluster prevention: 300 mg SC (3 injections) every 30 days while having an active cluster cycle |
Only preventative |
Side effects: constipation, injection site Warning: HTN (more pronounced in erenumab)
Not recommended in pregnant patients (must have 6 months free of antibodies before getting pregnant) |