From Current Studies: What Migraine Treatments Work?

New guidelines have just come out based on the evidence we currently have for migraine treatment.  We’ll talk about some of the guidelines in a moment, but first there are some key things to remember.

Caution: Dangerous Waters Ahead!

These guidelines were created by checking out the studies that have been published to date.  This means that we do or do not have high quality studies that show successful treatment using [whatever medication or supplement].  If we don’t have enough quality studies, the item will be lower on the list.

We should also note that the guidelines are talking about what works in general, NOT what works for you or what is best for you.  Some treatments high on the list are also high in side effects.  Or they may be dangerous for certain people.  Or they may not work well for your particular type of migraine.  Do not take this as a list of what to try first.  Something lower on the list may be something far better for you that something on the top.

This list also doesn’t address combo-treatments, such as MigreLief (with magnesium, feverfew and riboflavin).

The list does help doctors prioritize what to consider.  If you’ve tried a number of things and haven’t tried something high on the list, it may be time to ask your doctor about it.

Highest rated treatments

Here are some of the highest rated treatments for migraine.  There are four categories:

Lowest rated treatments

These are the items that had a negative rating, meaning that they’re not recommended at this time:  Lamotrigine, Clomipramine, Acebutolol, Clonazepam, Nabumetone, Oxcarbazepine, Telmisartan, montelukast.

Everything in-between

Of course, just because something isn’t on the top of the list doesn’t mean it’s not an excellent, helpful treatment for many people.  For example, very close to the top were well-recognized treatments such as amitriptyline, zolmitriptan, feverfew, naproxen sodium, riboflavin (vitamin B2), and magnesium.

It should also be noted that Botox migraine treatment was not a part of these studies.

For some of the medications that are being used today, check out Migraine Medications: So many choices.

To read more details about the new studies with all the little details, visit Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults and Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults.

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2 comments… add one
  • Bobbie Aug 21, 2013

    I live in the UK where treatments are often a bit different, and I was interested to see butterbur on your list as that’s not one I’ve heard of before. But I looked it up and came across this article which worried me. You shouldn’t be recommending something that comes with such a serious health risk. People think that just because something is herbal it can’t do them any harm, but they’re wrong!

    • James Aug 21, 2013

      Hi Bobbie!

      Thanks for your comment. We have since discussed concerns about butterbur – you can read more here:

      I’m also going to be posting again on Twitter and Facebook this morning.

      At the time when the article you’re linking to was posted, there was less of a concern about most respected brands, such as Petadolex (notice the article you mentioned is referring to “unlicensed” brands – which you probably want to avoid anyway). Most of these brands were concerned about the careful processing of butterbur. So although I did write about these concerns (see this article from 2006:, it seemed to be less of an issue come 2012.

      However, there is now a bit of a controversy. Safety measures that had been in place were apparently removed or changed, which has made doctors less enthusiastic about recommending it.

      I will include a link to the new information in the article above. I am confident that at least some of the companies making butterbur available will soon deal with these concerns, and we should be able to recommend it again in the future.

      Thanks for your note!

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