Key Points
ÎApproximately 38% of migraineurs need preventive therapy, but only less than a third of those eligible currently use it.
ÎEvidence to support pharmacologic treatment strategies for migraine prevention indicates which treatments might be effective but is insufficient to establish how to choose an optimal therapy. Treatment regimens, therefore, need to be designed case by case, which may include complex or even nontraditional approaches.
ÎFrequent use of aspirin, selected analgesics, and nonsteroidal anti- inflammatory drugs (NSAIDs) may exacerbate headache because of a condition called "medication overuse headache."
ÎComplete review and disclosure of coexisting conditions are warranted, since complementary or pharmacologic therapies taken for coexisting conditions (e.g., depression) may exacerbate headache.
ÎBecause migraine is frequent in women of childbearing age, the potential for adverse fetal effects related to migraine prevention strategies is of particular importance.
ÎPatient education and appropriate management are important in successful care of patients with migraine.
Note: It is important for patients to understand the magnitude of benefit that can be expected from preventive migraine therapies. For example, some patients may deem a 35% reduction in headache frequency or intensity an insufficient improvement, thus leading them to risk dose escalation.
