Are there risks associated with migraine preventives on the long term? 

It is not rare to stop migraine preventives after a trial.  80% of people with Chronic Migraine have stopped the preventive medications they were trying at 1 year. Lack of effectiveness and side effects are the key reasons. Botox probably has better success as it is well tolerated. 

Still, if a medication is effective and well tolerated, then long term effects and risks must be considered. Your physician should discuss this with you. We do not have long term data on all drugs. Studies were often done on the short term (a few months). 

This page does not discuss side effects that may occur on the short term. You can find these in another page (we apologize, there is a lot of information to share!). LINKIN 903

Table: Long term effect of migraine preventives (alphabetical order)
** Excellent review article by Vanderpluym at al. 

ProblemWays to prevent it
Amitriptyline
(Elavil)
Arythmias
Dementia
Check EKG
Botulinum toxin
(Botox)
No long term toxicity
Atrophy of the temporal muscles, usually not a problem
Weakness of neck and shoulder can appear if the patient loses weight or muscle mass.
Readjust protocol as needed
Candesartan
(Atacand)
Used for hypertension on the long term Monitor blood pressure
CGRP antibodies
(Aimovig, Ajovy, Emgality)
Long term exposure with erenumab up to 4 years did not reveal toxicity or unexpected health issues
Concerns of vascular risks still in discussion
More long term data needed
Propranolol
(Inderal)
Increased risk of diabetes
Information on long term lacking
Check glucose levels
Topiramate
(Topamax)
Osteoporosis (depends of duration more than dose)


Kidney stones (no surgery) – (1-10%)
Kidney stones (asymptomatic) – (20%)
Calcium, vitamin D exercise, less alcohol and stop smoking

Hydration
Low sodium diet
Valproic Acid
(Epival, Depakene)
NOT AND IDEAL OPTION:
Gastrointestinal (pancreatitis, hepatic failure, non-alcoholic fatty liver)
Hematological (leucopenia, thrombocytopenia, pseudolymphoma)
Neurological (essential tremor, parkinsonism)
Hepatic toxicity
Skin and cosmetic (alopecia, hirsutism, acne)
Reproductive health (sperm abnormalities, infertility in women, polycystic ovary syndrome)
Bone health (osteoporosis, osteopenia)
Body weight (weight gain), lipids and atherosclerosis (atherosclerosis, hyperlipidemia, metabolic syndrome)
Venlafaxine
(Effexor)
No long term studies

Now I am concerned! What should I do? 

The goal of this article is to inform you, not to scare you uselessly. Discuss with your physician. Taking a medication is always a decision of pros and cons. Medications can improve the quality of life, but people taking them should be aware of possible consequences. 

REFERENCES

VanderPluym J, Evans RW, Starling AJ. Long-Term Use and Safety of Migraine Preventive Medications. Headache. 2016;56(8):1335-43.

LINKIN

903

Post#906

Print This Post Print This Post