Table 5

Prophylactic drug treatments for migraine

Start dose (mg)Maximum dose (mg)Side effects, comments
Many of these drugs are unlicensed in this indication.
SSRIs, selective serotonin reuptake inhibitors.
Amitriptyline5–10200Sedation and dry mouth
Consider other tricyclics; SSRIs
Propranolol20320Cold limbs, nightmares
Atenolol may be better tolerated
Pizotifen0.53Weight gain, sedation, low efficacy
Valproate5001500Weight gain, teratogenicity
Consider gabapentin, topiramate
Methysergide18Limb pain, visceral fibrosis
6 months treatment, 1 month break