Paliatívna medicína a liečba bolesti 1/2010

Prophylactic treatment of migraine

Prophylactic drug treatment is foregrounded in attempt to reduce frequency, duration or severity of migraine attacks, further after inefficiency or contraindications of acute therapy. Drugs of the first choice are initially administrated, i. e. valproate, topiramate, metoprolol, flunarizine. If these drugs are not effective, are contraindicated or in case of comorbidity, we use drugs of the second choice (amitriptylin) or another prophylactic drugs. Monotherapy is preferred at first, prophylactic drugs may be combined. Duration of prophylaxis is usually 6–9–12 months. During menstrual migraine, nonsteroidal anti-inflammatory drugs (naproxen) or triptans (frovatriptan, naratriptan) are administrated intermittently, another option is hormonal prophylaxis. Using of magnesium is without risk during pregnancy. In resistant cases metoprolol can be applied. The failure of prophylaxis can be caused by the wrong diagnosis of the headache.

Keywords: migraine, prophylaxis, topiramate, valproate, betablockers, amitriptylin.