Guidelines for the prevention of migraine

Abstract

Treatment of migraine has traditionally been divided into managing acute attacks and prophylactic treatment. Treatment of acute migraine has been the subject of many research papers and review articles in recent literature partly at the cost of prophylactic treatment, which is the focus of this review. The objective of prophylactic therapy is to reduce frequency, duration and severity of attacks in addition to optimize the patient’s ability to function normally. Preventive therapy is usually undertaken in patients who have more than two migraine episodes per month or when less frequent have severely disabling headaches resistant to usual treatment. Beta-blocking drugs without intrinsic sympathomimetic activity (e.g. propranolol) are usually the first drugs of choice followed by tricyclic antidepressant agents (e.g. amitriptyline), non-steroidal anti-inflammatory drugs (e.g. naproxen), calcium antagonists (e.g. flunarizine) or valproate. The use of serotonin antagonists (e.g. methysergide) is limited because of their potential serious side effects. Migraine refractory to standard prophylactic therapy is very often the result of overuse of abortive antimigraine drugs. The choice of medication clearly depends on the patient’s profile (age, co-morbid medical conditions) and the contraindication and side effect profile of the drug.