The prevention of migraine: a critical review with special emphasis on beta-adrenoceptor blockers

Migraine is one of the most frequent neurological disorders affecting up to 15% of the general population. Many patients require not only management o f individual migraine episodes but also prophylactic treatment. beta -adren oceptor blockers, flunarizine and valproic acid have been established as fi rst-line agents for the prophylaxis of migraine attacks. Among the beta -ad renoceptor blockers propranolol and metoprolol are best documented and henc e deserve preferential use. On the other hand, it appears that other beta - adrenoceptor blockers, perhaps with the exception of those with intrinsic s ympathomimetic activity, can be equally effective. Uncertainties regarding the relative merits of various treatment modalities are largely caused by l ack of adherence to specific requirements for clinical trials on migraine p rophylaxis. Therefore, this article reviews internationally recommended con ditions for reliable studies on migraine prophylaxis and appraises individu al agents in the light of these criteria.