Practice and Economics Cost Considerations in Headache Treatment Part 1: Prophylactic Migraine Treatment

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Abstract
Effective migraine treatment is clearly the most cost‐effective in terms of both direct and indirect costs. Patient education, behavior changes, and prudent medication selection can minimize costs. Low‐dose aspirin may reduce headache frequency. Among the antidepressant medications used, amitriptyine 25 mg, 3 qhs ($4.16/month) and doxepin 25 mg, 3 qhs ($10.50/month) remain the standard. Imipramine (25 mg, 3 qhs ($3.75/month) is very inexpensive and should replace nortriptyline 25 mg, 3 qhs ($64.29/month) as a second‐line agent. The specific serotonin reuptake inhibitors are expensive and have no proven effect for migraine prevention.Propranolol 80 mg bid ($7.80/month) is inexpensive and frequently a good choice among beta‐blockers. Atenolol 100 mg qd ($27.50/month) is less expensive than long‐acting propranolol 160 mg ($35.56/month) and nadolol 120 mg qd ($43.68/month) with equivalent effectiveness. It is thus recommended as the ong‐acting beta‐blocker of choice. Sustained‐release preparations of verapamil 240 mg qd ($31.98/ month) are twice the cost and less well‐absorbed than the standard preparation of 120 mg bid ($17.62/month).Better information is needed concerning effectiveness and optimal dosing of some older low‐cost medications in the preventive treatment of migraine.

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