Paper I
2020 February (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Drug therapy of migraine prophylaxis

Q53 marksShort Notes

Answer

Migraine prophylaxis is indicated for frequent (≥4/month) or severe/disabling attacks.

Drugs used

  • Beta blockers: Propranolol (first-line)
  • Tricyclic antidepressants: Amitriptyline
  • Anticonvulsants: Sodium valproate, Topiramate
  • Calcium channel blockers: Flunarizine
  • Newer agents: CGRP antagonists (Erenumab)

Rationale

  • Taken regularly (not during an acute attack) to reduce frequency, severity, and duration of attacks by modulating central pain pathways, serotonergic tone, and vascular reactivity
  • Choice guided by comorbidities (e.g., propranolol if coexisting hypertension; amitriptyline if coexisting depression/insomnia)

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