Migraine prevention is most effective when a preventive medication and behavioral management are combined together. A study by Dr. Holroyd and his colleagues published in the British Medical Journal showed that a beta blocker alone and behavioral management alone did not help patients with migraine headaches. However, combining these two resulted in a significant improvement. This was a very rigorous trial involving 232 patients who were divided into 4 groups: behavioral management alone (with a placebo pill), beta blocker alone, both interventions, and no intervention group (they did receive placebo pills). Patients and doctors did not know which patient received a beta blocker or placebo. Every patients was seen every month for four months and had 3 telephone calls in these four months. During each visit the behavioral management group received one hour of training. All patients were given optimal acute therapy with a triptan and if needed, ibuprofen and a nausea medication.
All patients were evaluated 10 and 16 months later and the combined group was improved compared to the other 3 groups both in the number of attacks, number of migraine days, and in the quality of life.
This confirms the validity of our usual practice of combining several approaches at once rather than trying one at a time. The list of our typical recommendations includes combination of several of these options: avoidance of caffeine, aerobic exercise, behavioral management, magnesium and other supplements, Botox injections, non-prescription medications, such as ibuprofen, naproxen, and Migralex, as well as triptans and prophylactic medications, such as beta blockers, epilepsy drugs, and antidepressants.
