Authors: Sarah Hamilton, Sneed KB, Yashwant Pathak.
Migraines are a neurological disorder that negatively affects the lives of many around the world. This review article will focus on the different medications that are currently used to prevent migraines from occurring, focusing on how they work and if they’re effective. Currently most of the medications used to prevent migraines are repurposed oral medications. Antidepressants that are tricyclic antidepressants, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are used. The beta-blockers that are used in migraine prevention are propranolol, metoprolol, and timolol. The anti-epileptics that are used are topiramate and divalproex. Another form of medication that is used is a series of onabotulinumtoxinA injections using the PREEMPT paradigm injection mode. The newest development in migraine preventatives is the CGRP targeting drugs. There are the drugs Galcanezumab, eptinezumab, fremanezumab and erenumab, which use monoclonal antibodies. The second type of CGRP targeting medication uses small molecules and are CGRP receptor antagonists, the only preventive in this category is atogepant. All these medications have evidence that show that they are effective at preventing migraines, but they also all have side effects. When considering which medications are the best option the side effects and a patients other conditions have to take into consideration. Looking at what is currently not understood about migraine pathophysiology and the current direction preventative medication for this condition is headed helps to determine what future trends for this field will be.
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