Table 4: Medications recommended for migraine prophylaxis[10,14,63,74-141,157,158]
Medication	Dosage	Main side effect	Level of evidence
ß-blockers[76-94] Atenolol Metoprolol Nadolol Propranolol	50-150 mg/d 100-200 mg/d 20-160 mg/d 40-240 mg/d	Fatigue, bronchospasm, bradycardia, hypotension, congestive heart failure, depression, impotence, sleep disturbance	I
Calcium-channel blockers[85-90,92-104] Flunarizine Verapamil	5-10 mg/d 240-320 mg/d	Fatigue, weight gain, depression (flunarizine), bradycardia, hypotension, constipation (verapamil), nausea, edema, headache, extrapyramidal side effects	I
Serotonin receptor antagonists[105-117] Methysergide	2 mg every night, gradually increased to tid (maximum 8 mg/d if needed) (usual dose 4-8 mg/d)	Retroperitoneal, cardiac and pulmonary fibrosis	I
Pizotyline (pizotifen)	0.5 mg every night, gradually increased to tid (maximum 3-6 mg/d if needed) (usual dose 1-6 mg/d); consider giving higher doses once every night	Weight gain, fatigue	I
Tricyclic analgesics[118,119] Amitriptyline Nortriptyline	10-150 mg every night 10-150 mg every night	Dry mouth, constipation, weight gain, drowsiness, reduced seizure threshold, cardiovascular effects	I I
Anti-epileptics[120-126] Divalproex Sodium valproate Valproic acid	500-1500 mg/d 500-1500 mg/d 500-1500 mg/d	Nausea, tremor, weight gain, alopecia, increased liver enzyme levels	I
NSAID[91,127-131,157,158] Naproxen sodium*	550 mg bid, for no longer than 1 wk per mo	GI upset, ulceration, rebound headache, renal dysfunction	I
*As prophylaxis for perimenstrual migraine attacks only.

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