Via practica 6/2009

Preventive treatment of migraine

The treatment of migraine may be acute (abortive) or preventive (prophylactic). Preventive therapy is used in an attempt to reduce the frequency, duration and severity of attacks. Additional benefits include enhancing the response to acute treatments, improving a patient’s ability to function, and reducing disability. The major medication groups for preventive migraine treatments include betablockers, calcium channel antagonists, anticonvulsants, antidepressants, serotonin antagonists, nonsteroidal anti-inflammatory drugs, and others (botulotoxin, magnesium, riboflavin, coenzym Q10). If preventive medication is indicated, the agent should be chosen from first-line categories, based on the drug´s relative efficacy in double blind, placebo-controlled trials, its side effect profile, coexistence of comorbid conditions and the patient’s preference. The drugs of first choice are propranolol or metoprolol (beta-blockers), valproic acid or topiramate (anticonvulsants), flunarazine (calcium channel antagonist), and in USA also amitriptyline.

Keywords: migraine, preventive treatment, indications, drugs of first choice