ABSTRACT
There are two major shortcomings with prophylactic therapies for migraine. The first is that on average, efficacy rate of any prophylactic agent does not exceed 50% in most patients. The second is that most prophylactic drugs are endowed with a high prevalence of uncomfortable and sometimes intolerable adverse effects. It is therefore of clinical interest that several treatments nearly devoid of adverse effects are available for migraine prophylaxis. Among them are vitamins like riboflavin and herbs, or plants like feverfew or butterbur. Other ‘‘natural’’ elements like coenzyme Q10 and thioctic acid (a-lipoic acid) have also been studied. In this chapter, we will review published data for these medications as well as for magnesium. Magnesium is also considered a ‘‘soft’’ treatment, and its preventive action in migraine has been explored in several randomized controlled trials. We will focus on efficacy data on 50% responder rates in absolute and, if available, in placebo-subtracted values, and compare the data with those published in recent trials for slow release propranolol 160mg (1) and for valproate (2), two mainstays in preventive antimigraine treatment.
