title: Current practice and future directions in the prevention and acute management of migraine.
abstract: Migraine is a common and disabling brain disorder with a strong inherited component. Because patients with migraine have severe and disabling attacks usually of headache with other symptoms of sensory disturbance (eg, light and sound sensitivity), medical treatment is often required. Patients can be managed by use of acute attack therapies (eg, simple analgesics or non-steroidal anti-inflammatory drugs) or specific agents with vasoconstrictor properties (ie, triptans or ergot derivatives). Future non-vasoconstrictor approaches include calcitonin gene-related peptide receptor antagonists. Preventive therapy is probably indicated in about a third of patients with migraine, and a broad range of pharmaceutical and non-pharmaceutical options exist. Medication overuse is an important concern in migraine therapeutics and needs to be identified and managed. In most patients, migraine can be improved with careful attention to the details of therapy, and in those for whom it cannot, neuromodulation approaches, such as occipital nerve stimulation, are currently being actively studied and offer much promise.
authors.affiliation: Department of Neurology, University of California, San Francisco, 94115, USA. pgoadsby@headache.ucsf.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
mesh_terms: D015670:Acupuncture Therapy / Q000639:trends; D000818:Animals; D001905:Botulinum Toxins / Q000627:therapeutic use; D019468:Disease Management; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D013997:Time Factors; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D014363:Tryptamines; D001905:Botulinum Toxins