When do you consider prescribing memantine for migraine treatment?

Memantine is well-tolerated and shows excellent efficacy for prevention in both chronic and high-frequency episodic migraine. The main limitation is that it is not FDA-approved, and payors use this as an excuse to deny coverage in favor of less-well-tolerated, and often less efficacious but cheaper ...

I consider memantine in cases where there has been a reduction in severity and frequency of migraine on other preventative medications, but not to the extent that the patient is satisfied. I also consider it in cases where the patient is sensitive to medications, as it is well-tolerated in most case...

Never. We have so many migraine suppressive medications that are highly effective. I do recommend vitamin B, vitamin D, magnesium, eye vitamins, alpha lipoic acid, better hydration, better sleep, reduced stress if possible, and avoidance of individual triggers.

Robert Burger, M.D.

Agree with Dr. @Dr. First Last, though, I typically counsel my patients to specifically aim for B2 (which does have data behind it) and avoid B-complexes, given even a slight risk of excess B6 (have come across quite a few in training days).