What is the most effective prophylactic medication for migraine headaches?. Issue 6 (June 2016) - Grubbs, Calvin
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).