The first choice of prophylactic drugs for migraine caused by the extract of Scutellaria and topiramate

Recently, the latest migraine prevention and treatment guidelines of the American Academy of Neurology (AAN) and the American Headache Society (AHS) listed topiramate and butterbur extract together with dipropionate, valproate, metoprolol, propranolol and timolol as the first choice drugs to prevent migraine, and pointed out that all the above drugs can effectively prevent migraine and reduce the frequency and severity of migraine attack Dr Stephen Silberstein, a professor of Neurology at the Jefferson School of medicine and the lead author, pointed out that the new guidelines reflected the latest research results and included medication recommendations for about 40 drugs and 20 commonly used over-the-counter drugs (OTC), including non steroidal anti-inflammatory drugs, from nearly 300 studies with the most evidence For example, at the time of the publication of the 2000 edition of the guidelines, there was insufficient evidence of topiramate, but there is now evidence of its effectiveness One study showed that topiramate 50 mg / D for 8 weeks reduced the frequency of migraine attacks from 6 times a month at baseline to about 2 times a month, and reduced the severity and duration of headache In addition, the study also found that fluvastatin can effectively prevent menstrual migraine At the same time, due to the lack of sufficient evidence for strong recommendations, the new guidelines reduce the recommendation level of verapami and gabapentin Dr Silberstein also pointed out that the new guidelines are more stringent, including more detailed terms for OTC and nutrition, and provide evidence of the ineffectiveness of certain drugs, such as carbamazepine and lamotrigine, which appear to be effective for migraine aura but not for headache In general, the recommendations for these drugs may not surprise many doctors, but rather support their views and provide evidence for their clinical practice However, doctors may be unfamiliar with the good evidence of butterbur extract This is the only OTC product that can effectively prevent migraine, rather than "very likely" or "possibly" effective Studies have shown that twice daily administration of 75 mg of butterbur extract can reduce the frequency of migraine attack by 48%, significantly better than placebo In view of so many effective drugs and OTC products, the choice of drugs will largely depend on the characteristics of side effects of drugs and patients' complications For example, topiramate is more suitable for obese patients because it helps to lose weight Topiramate and valproate are also the best choice for epileptics Beta blockers may be more suitable for patients with anxiety or idiopathic tremor, but they cannot be used for patients with asthma If the migraine attack is more than 1 time / W, the drug treatment fails or the dosage is too large in the acute phase, and the aura period is too long or accompanied with hemiplegia and other uncomfortable neurological symptoms, preventive drugs can be taken Despite the high upfront cost of preventive drugs, migraine prevention can reduce the total medical cost.