Via practica 3/2021

Biologic treatment versus prophylactic treatment of migraine

Migraine is one of the primary headaches and significantly affects patients’ quality of life. Approximately 38 % of patients with episodic migraine require preventive therapy, but only 3–13 % receive prophylactic treatment indeed. Prophylactic treatment reduces the frequency of attacks, pain intensity and side symptoms resulting from chronic pain, thereby improving quality of life as well. Migraine prophylaxis should be considered for patients with at least 2 migraine attacks per week and/or at least 8 monthly, debilitating headaches, drug-overused headache, long-lasting migraines for more than 48 hours, intolerance or contraindication to symptomatic treatment, presence of certain migraine subtypes (i.e., hemiplegic migraine, migrainous infarction etc.). The elimination and identification of environmental, dietary and behavioral trigger factors is necessary for migraine prevention and further treatment strategy. The first line treatment for migraine prophylaxis includes propranolol, metoprolol, amitriptylin, pizotifene, topiramate and naproxen. In case of inefficiency, administration of onabotulotoxin type A as well as the latest biological treatment with monoclonal antibodies may be considered.

Keywords: migraine, monoclonal antibodies, biologic treatment, prophylactic treatment