ÎPatients should also be instructed how to use their medications, how to identify changes in their headache status, when to return to the clinic, and what to do when they need rescue medication for their acute and breakthrough migraine attacks.
Coexisting Conditions
ÎConcomitant medications taken to treat different conditions may interfere with efficacy of both medications and may lead to exacerbation of adverse events.
ÎPatients will need to learn which medication should be used for migraine prevention and how to treat migraine exacerbations. This will differ from how to treat other coexisting conditions such as depression or anxiety.
ÎWomen wanting to become pregnant may not realize the risks associated with daily dosing using OTC/complementary treatments for migraine prevention.
US Headache Consortium Consensus on When to Initiate Preventive Pharmacologic Treatment
Medication Use
ÎInitiate therapy with medications that have the highest level of evidence- based efficacy.
ÎInitiate therapy with a low dose of the drug and titrate upward slowly until clinical benefits are achieved in the absence of, or until limited by, adverse events.
ÎGive each drug an adequate trial. It may take as long as 2 to 3 months to achieve clinical benefit, and 6 months to achieve maximal benefit, after achieving a clinically effective dose.
ÎAvoid medications that increase headache frequency or severity (e.g., overuse of acute headache medications).
Evaluation
ÎMonitor the patient's headache and headache medication consumption through a headache diary.
ÎMonitor the disability/impact associated with headache.
ÎRe-evaluate therapy. After 6-12 months of excellent control of headache frequency and severity, discuss tapering or discontinuing treatment with the patient.
Patient Education
ÎMaximize compliance. Discuss with the patient the rationale for a particular treatment, when and how to use it, and the potential adverse events.
ÎAddress patient expectations. Discuss with the patient the expected benefits of therapy and how long it will take to achieve them.
ÎCreate a formal management plan.
