ABSTRACT
Migraine is a primary headache disorder characterized by recurring attacks of pain
and associated symptoms. Migraine sufferers require a continuum of clinical care that
depends on their disability and response to treatment. Treatment consists of: (1)
prevention of attacks by avoidance of triggers; (2) the use of nonpharmacologic treatments;
(3) treatment of the acute attack; and (4) long-term prophylactic therapy. Migraine
is comorbid for affective disorders, epilepsy, stroke, and mitral valve prolapse.
The therapy selected depends on the headache severity and frequency, the pattern of
associated symptoms, comorbid illnesses, and the patient's treatment response profile.
Acute treatment can be symptomatic or specific, using drugs such as dihydroergotamine
(DHE) or sumatriptan. Preventive treatment can be episodic, subacute, or chronic.
The major drug groups include beta-adrenergic blockers, anti-depressants, calcium
channel blockers, serotonin antagonists, anticonvulsants, and nonsteroidal anti-inflammatory
drugs (NSAIDs). These can be divided into two major categories and second-line choices.
Keywords
Migraine - migraine status - comorbidity - preventive treatment - acute treatment
- primary headache - nonpharmacologic treatment
