Abstract

Evidence-Based Answer Propranolol, timolol, valproic acid, topiramate, and amitriptyline are FDA-approved and similarly effective for migraine prophylaxis when compared with placebo. Angiotensin-converting enzyme (ACE) inhibitors may be more effective than other treatments such as amitriptyline, anti-epileptics, and NSAIDs. Gabapentin is ineffective for preventing migraines (SOR: A, systematic reviews of RCTs). OnabotulinumtoxinA reduces the frequency of chronic migraine attacks but efficacy compared with other treatments is unknown (SOR: B, one RCT).

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