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  • Dr. Simon Moore MD CCFP

Know these NEW Migraine Prevention Meds: The 5As

"The 5 As" is a helpful tool that can help you remember the key preventive treatments for migraine should this appear in a SAMP, SOO, or your next clinic patient.

This information was recently featured in CMAJ so be sure to know all of the following:

1. Antihypertensives

Some antihypertensive medications have been found to be effective in reducing the frequency and severity of migraines. These include:

  • β-blockers such as metoprolol

  • ACE inhibitors such as Lisinopril

  • ARBs (angiotensin receptor blockers) such as candesartan

2. Antidepressants

Certain antidepressant medications have been shown to help prevent migraines, including:

  • Venlafaxine (SSRI)

  • Amitriptyline (Tricyclic antidepressant)

3. Anticonvulsants

Some anticonvulsant medications have been proven to be effective in migraine prevention, such as:

  • Valproate (increases the inhibitory neurotransmitter gamma-aminobutyric acid (GABA))

  • Topiramate (anticonvulsant)

4. NEW: Antagonists of Calcitonin Gene-Related Peptide (CGRP)

These medications target CGRP, a neuropeptide involved in migraine pathophysiology. Examples of these drugs include:

  • Erenumab: A monoclonal antibody that specifically targets the CGRP receptor, helping to prevent migraine attacks.

  • Galcanezumab, fremanezumab, and eptinezumab: These monoclonal antibodies target CGRP itself, blocking its activity and potentially reducing migraine frequency and severity.

5. Botox (onabotulinumtoxinA)

The fifth "A" is for the A in onabotulinumtoxinA. This treatment is specifically used for chronic migraines and not episodic ones. Botox injections can help prevent migraines by blocking the release of neurotransmitters that transmit pain signals in the brain.

6. BONUS: Supplements

There is also low-level evidence for magnesium, Coenzyme Q10, Riboflavin, and moderate evidence for Butterbur for migraine prevention. Caution: the butterbur plant can contain carcinogens so only specific commercially-prepared products are recommended.

Source: CMAJ February 06, 2023 195 (5) E187-E192;



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