Article: Effective migraine prophylaxis remains elusive.(Clinical Rounds)

WASHINGTON -- Newer drugs aren't any better for migraine prophylaxis than are older treatments--and they may be worse choices for many patients when cost is a factor.

"There's no proof of increased efficacy with the newer drugs," said Dr. Gretchen E. Tietjen, chair of the department of neurology at the University of Toledo (Ohio).

Topiramate (Topamax), a newer drug, has been compared with several other drugs in head-to-head, double-blind studies, including divalproex sodium, nadolol, propranolol, and amitriptyline, she said at the annual meeting of the American College of Physicians. "'In these head-to-head studies, there was similar efficacy."

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