Take this brief quiz to test your knowledge of recent recommendations from the American Headache Society for the prevention and acute management of migraine.
Ready to test your knowledge of the AHS recommendations? Scroll through the slides to take the 5-question quiz.
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Discussion: Strategies for avoiding medication overuse include adjusting dosage and/or therapy in patients with an inadequate response, limiting treatment to about two headache days per week, and offering preventive treatment when indicated.1
Discussion: Other indications for preventive therapy include migraine that significantly interferes with daily activities, contraindication/failure/overuse of acute therapy, adverse events to acute treatment, preference for preventive therapy, and/or certain types of migraine (eg, migraine with prolonged aura). The AHS statement also lists modified criteria for identifying patients for preventive therapy.1
Discussion: The AHS considers the following oral treatments to have established efficacy for prevention of migraine: antiepileptic drugs (divalproex sodium, valproate sodium, topiramate); beta-blockers (metoprolol, propranolol, timolol); and frovatriptan (for short-term prevention of menstrual migraine). Note that women of childbearing potential who are not using reliable birth control should not take valproate sodium or topiramate, because of the risk of birth defects.1
Discussion: Oral preventive treatments for migraine should be given an adequate trial duration of at least 8 weeks. If there is no response after 8 weeks, switching to another preventive treatment is advisable.1
Discussion: Biobehavioral therapies with Grade A evidence for effectiveness in the preventive treatment of migraine include CBT, biofeedback, and relaxation therapy. Other biobehavioral approaches include education and lifestyle modification, such as minimizing exposure to triggers. Combining biobehavioral therapies with medications has more benefits than either alone.1
1. American Headache Society. The American Headache Society Position Statement on Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019;59:1-18. doi: 10.1111/head.13456.