Preventive migraine treatment.
The pharmacologic treatment of migraine may be acute (abortive) or preventive (prophylactic), and patients with frequent severe headaches often require both approaches. Preventive therapy is used to try to reduce the frequency, duration, or severity of attacks. The preventive medications with the best-documented efficacy are amitriptyline, divalproex, topiramate, and the beta-blockers. Choice is made based on a drug's proven efficacy, the physician's informed belief about medications not yet evaluated in controlled trials, the drug's adverse events, the patient's preferences and headache profile, and the presence or absence of coexisting disorders. Because comorbid medical and psychologic illnesses are prevalent in patients who have migraine, one must consider comorbidity when choosing preventive drugs. Drug therapy may be beneficial for both disorders; however, it is also a potential confounder of optimal treatment of either.
Silberstein
Stephen D
SD
Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospital, 111 South Eleventh Street, Gibbon Building, Suite 8130, Philadelphia, PA 19107, USA. stephen.silberstein@jefferson.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000927:Anticonvulsants; D000928:Antidepressive Agents; D002121:Calcium Channel Blockers; D019274:Botulinum Toxins, Type A