23-year-old man with a history of migraine presents for review. His headaches are now occurring about once a week. He describes unilateral, throbbing headaches that may last over 24 hours. Neurological examination is unremarkable. Other than a history of asthma he is fit and well. What is the most suitable therapy to reduce the frequency of migraine attacks?
Propranolol
Zolmitriptan
Topiramate
Amitriptyline
Pizotifen
Topiramate
Migraine
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
Pizotifen is used less commonly nowadays due to side-effects such as weight gain. Propranolol should be avoided in asthmatics.