Pharmacologic prevention of migraine
Abstract
CMAJ | February 6, 2023 | Volume 195 | Issue 5 E187 In this second in a series of 2 reviews focusing on the management of migraine, we discuss pharmacologic treatments that health care practitioners may prescribe to help reduce the frequency, severity, duration and disability of patients’ migraine attacks and optimize their use of medications for acute headache treatment. Our first article1 discussed diagnosis and acute treatment; herein, we focus on migraine prevention, an important part of management for which evidence is accumulating. The 2021 American Headache Society consensus guideline recommends that preventive pharmacologic therapy should be considered for patients with 4 or more migraine headache days per month or those with 2 or more migraine headache days per month that are associated with substantial disability despite use of acute medication.2 Preventive treatment should also be considered for patients with atypical aura (hemiplegic migraine, migraine with brain stem aura) and migraine with associated complications (e.g., persistent aura, migrainous infarction [stroke], migraine aura–triggered seizure, status migrainosus), even if the frequency of attacks is low.2 We draw on original research, reviews and clinical practice guidelines (Box 1).
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