TABLE 3.
Side effects and contraindications of migraine prophylactic medications.
| Medication | Side‐effects | Contraindications |
|---|---|---|
| Antiepileptics | ||
| Topiramate | Cognitive slowing, weight loss, depression, paresthesia | Pregnancy |
| Lamotrigine | Rash, nausea, dizziness | Cardiac arrhythmias |
| Valproic acid | Nausea, vomiting, hair loss, easy bruising, tremor, weight gain, hepatotoxicity | Pregnancy |
| Gabapentin | Somnolence, cognitive slowing | Pregnancy |
| Calcium channel blockers | ||
| Flunarizine, cinnarizine (not FDA approved) | Headache, lightheadedness, flushing, parkinsonism (rare) | Pregnancy |
| Verapamil | ECG abnormalities at doses above 480 mg/day, edema, gastrointestinal discomfort, dull headache, gingival hyperplasia | Underlying heart disease (relative) |
| Tricyclic anti‐depressants | ||
| Amitriptyline | Hypersomnolence (higher than nortriptyline), orthostasis, mild QTC prolongation, dry mouth, constipation, tachycardia, palpitations, weight gain, blurred vision, urinary retention, lower seizure threshold at high doses, sexual dysfunction | Underlying heart disease (relative) |
| Nortriptyline | Hypersomnolence (less than amitriptyline), orthostasis, dry mouth, mild QTC prolongation, constipation, tachycardia, palpitations, weight gain, blurred vision, urinary retention, lower seizure threshold at high doses | Underlying heart disease (relative) |
| SNRIs and SSRIs | ||
| Venlafaxine | Nausea, hypertension, dizziness, dry mouth, sexual dysfunction | ‐ |
| Paroxetine | Orthostasis, sexual dysfunction, weight gain, drowsiness | Pregnancy |
| Beta‐blockers | ||
| Propranolol | Fatigue, depression, sexual dysfunction, hypoglycemia, hyperkalemia | Severe bronchospastic disease |
| Metoprolol | Fatigue, depression, sexual dysfunction | Severe bronchospastic disease (less than propranolol) |
| Angiotensin II receptor antagonists | ||
| Candesartan | Back pain, dizziness, and cold‐ or flu‐like symptoms | None |
Note: Sources include Ko et al., 80 Beumer and Hardonk, 81 Singh et al., 82 Skinner et al., 83 Reid et al., 84 Castellino et al., 85 Deacon and Barnett, 86 Shorr et al., 87 Capella et al., 88 Chouza et al., 89 Anderson et al., 90 Stahl et al., 91 Wenzel‐Seifert et al., 92 Hirsch et al., 93 Arif et al., 94 Abou‐Khalil, 95 Biton et al., 96 Nasreddine and Beydoun, 97 Cohen et al. 98 and Tomson et al. 99