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There is little evidence-based information about selecting prophylactic drug strategies for migraine headache, Dr. Neil H. Raskin said at the annual meeting of the American Headache Society.
Evidence is weak at best for the efficacy of the two drug classes with the least noxious side effect profiles--calcium channel antagonists and the newer anticonvulsants. Yet despite a paucity of controlled trials, these drugs do have some less-rigorous evidence behind them, said Dr. Raskin of the University of California, San Francisco.
He stated his preference for starting patients on the new calcium channel antagonist amlodipine because of its bland side effect profile. It avoids the weight gain seen in patients on valproate, 40% of whom gain as much as 50-60 pounds.
Dr. Raskin suggested starting with an amlodipine dosage of 2.5 mg/day and increasing it gradually to 7.5-12.5 mg/day. He occasionally goes as high as 15 ...
Source: HighBeam Research, Migraine Prophylaxis.