Abstract text (incl. figure legends and references)
Background

Preventive medications are key in migraine prevention. In cases of refractory migraine headaches, multiple medications may be required. We seek to identify a comprehensive list of preventive migraine headache medications that can be used in two, three, or four combinations without drug-drug interactions.

We compiled a list of prevention medications from Szperka et al's "Migraine Care in the Era of COVID-19" as well as American Headache Society's 2018 and 2021 consensus statements on integrating new migraine treatments into clinical practice. We obtained all possible two to four combinations of prevention medications through this list. We then filtered out all combinations containing at least one interaction based on DrugBank or FAERS database.

A total of 27 unique prevention medications are identified. There are a total of 351 combinations of two preventives, 2925 combinations of three preventives, and 17550 combinations of four preventives. When screened using DrugBank, there are a total of 115, 113, and 0 non-interacting two, three, and four preventive combinations, respectively. All non-interacting medications can be represented by a condensed list of 147 unique combinations of medications. When screened using FAERS, there are a total of 288, 1742, and 6875 non-interacting two, three, and four preventive combinations. The non-interacting medications can be represented by a condensed list of 6902 unique combinations of medications.

This list of migraine preventive medications with out drug-drug interactions is an useful tool for clinicians seeking to manage refractory headaches more effectively by implementing an evidence-based polypharmacy.