Appendix B: Summary of Evidence-based Guideline for Clinicians, Update: NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults.

Are nonsteroidal antiinflammatory drugs (NSAIds) or other complementary treatments effective for migraine prevention? histamines/Antihistamines/Leukotriene receptor Antagonists moderate evidence Histamine sc is probably effective and should be considered for migraine prevention (Level B). Montelukast is probably ineffective and should not be considered for migraine prevention (Level B negative). Weak evidence Cyproheptadine is possibly effective and may be considered for migraine prevention (Level C). NSAIds moderate evidence Fenoprofen, ibuprofen, ketoprofen, naproxen, and naproxen sodium are probably effective and should be considered for migraine prevention (Level B). Weak evidence Flurbiprofen and mefenamic acid are possibly effective and may be considered for migraine prevention (Level C). Insufficient evidence Evidence is inadequate or conflicting to support or refute the use of aspirin or indomethacin for migraine prevention (Level U). Clinical context Regular or daily use of selected NSAIDs for the treatment of frequent migraine attacks may exacerbate headache because of development of a condition called medication overuse headache. Therefore, use of aspirin, selected analgesics, and NSAIDs may exacerbate headache; use of these agents in migraine prevention studies may confound the clinical interpretation of the study results. herbal preparations, vitamins, minerals, and Other Interventions Strong evidence Petasites (butterbur) is established as effective and should be offered for migraine prevention (Level A). moderate evidence Riboflavin, magnesium, and MIG-99 (feverfew) are probably effective and should be considered for migraine prevention (Level B). Weak evidence Coenzyme Q10 and estrogen are possibly effective and may be considered for migraine prevention (Level C). Insufficient evidence Evidence is inadequate or conflicting to support or refute the use of omega 3 or hyperbaric oxygen therapy for migraine prevention (Level U).