title: Preventive treatment of migraine.
abstract: Migraine is a common episodic pain disorder, the treatment of which can be acute to stop an attack or preventive to reduce the frequency, duration or severity of attacks. Preventive treatment is used when attacks are frequent or disabling. Many different medication groups are used for preventive treatment, including beta-blockers, antidepressants and antiepileptic drugs. Their mechanisms of action include raising the threshold to migraine activation, enhancing antinociception, inhibiting cortical spreading depression, inhibiting peripheral and central sensitization, blocking neurogenic inflammation and modulating sympathetic, parasympathetic or 5-HT tone. In this article, I review evidence of the effectiveness of migraine preventive drugs. I also discuss the setting of treatment priorities.
authors.affiliation: Jefferson Headache Center, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. stephen.silberstein@jefferson.edu
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Silberstein
mesh_terms: D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D008959:Models, Neurological; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000145:classification; D017410:Practice Guidelines as Topic
chemical_list: D004364:Pharmaceutical Preparations