I have found amitryptiline followed by propranolol to be the most effective drugs for migraine prophylaxis when lifestyle changes have failed. Patient preference is of course important but it seems to be another clinical neuropharmacological area where old and cheap is better?
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@ajlees
Riboflavine, Vitamin B2, is also remarkable. Using it for years, but on recent experience, not enough.
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@ajlees
Great meds
For the folks out there playing from home, remember no TCAs for older adults due to anticholinergic effects
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@MemoryDoc
The elderly generally tolerate up to 25 mg amitryptiline well in my opinion anf of course most migraineurs are young
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@ajlees
Propranolol was - and still is - my first choice for all migraine patients (who are not asthmatic).
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@ajlees
The two most effective drugs in my practise too with a slight preference to propranolol over amitryptiline.
However in people with depression i have noticed venlafaxine working slightly better than amitryptiline.
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