Table 10 Drugs used by specialists in chronic migraine prophylaxis
From: Aids to management of headache disorders in primary care (2nd edition)
Topiramate, 50 mg or more twice daily | |
Onabotulinum toxin A, 155-195 units by multisite injection | • not licensed for chronic migraine in some countries, or • not reimbursed, and/or • regulators require prior failure of two or more of the drugs used in prophylaxis of episodic migraine |
CGRP monoclonal antibodies (to the peptide or its receptor): • erenumab 70 or 140 mg s/c once monthly • fremanezumab 225 mg s/c once monthly or 675 mg s/c once quarterly • galcanezumab 240 mg s/c, then 120 mg s/c once monthly | • newly licensed, not yet universally available or reimbursed, usually restricted to specialist care and reserved for those failing (or not tolerating) other prophylactics • all self-administered by auto-injector • high relative cost |