Acute and Preventive Migraine Treatments: A 5-Question Quiz

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