Skip to main content

Migraine prophylaxis: key points for the practising clinician

Neurological Sciences volume 30, pages 33–37 (2009)Cite this article

Abstract

Migraine is a significant burden on individuals and society. Patients with most severe forms require preventive treatments, whose aim is to reduce the frequency and severity of attacks and consequently the overall impact of migraine. Although various medications are available for migraine prophylaxis, only a minority of migraineurs receive these drugs. This brief paper summarizes the most important indications for starting migraine prophylaxis, and provides an overview of the salient characteristics of available preventive drugs, to guide the choice of the most appropriate medication for a given patient.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(Suppl 1):1–160

    Google Scholar 

  2. Bussone G, Usai S, Grazzi L, Rigamonti A, Solari A, D’Amico D (2004) Disability and quality of life in different primary headaches: results from Italian studies. Neurol Sci 25(Suppl 3):S105–S107

    PubMed  Article  Google Scholar 

  3. Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ (2003) The family impact of migraine: population-based studies in the USA and UK. Cephalalgia 23(6):429–440

    PubMed  Article  CAS  Google Scholar 

  4. Dueland AN, Leira R, Burke TA et al (2004) The impact of migraine on work, family, and leisure among young women—a multinational study. Curr Med Res Opin 20:1595–1604

    PubMed  Article  Google Scholar 

  5. Steiner TJ, Scher AI, Stewart WF et al (2003) The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia 23:519–527

    PubMed  Article  CAS  Google Scholar 

  6. Osterhaus JT, Townsend RJ, Gandek B et al (1994) Measuring the functional status and well-being of patients with migraine headache. Headache 34:337–343

    PubMed  Article  CAS  Google Scholar 

  7. Dahlof CGH, Dimenas E (1995) Migraine patients experience poorer subjective well-being/quality of life even between attacks. Cephalalgia 15:31–36

    PubMed  Article  CAS  Google Scholar 

  8. Terwindt GM, Ferrari MD, Tijhuis M et al (2000) The impact of migraine on quality of life in the general population. Neurology 55:624–629

    PubMed  CAS  Google Scholar 

  9. Silberstein SD, for the US Headache Consortium (2000) Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 55:754–762

    PubMed  CAS  Google Scholar 

  10. Members of the task force, Evers S, Afra J, Frese A et al (2006) EFNS guideline on the drug treatment of migraine—report of an EFNS task force. Eur J Neurol 13:560–572

    PubMed  Article  CAS  Google Scholar 

  11. Diamond S, Bigal ME, Silberstein S et al (2007) Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention Study. Headache 47:355–363

    PubMed  Google Scholar 

  12. Lucas C, Géraud G, Valade D et al (2006) Recognition and therapeutic management of migraine in 2004, in France: results of FRAMIG 3, a French nationwide population-based survey. Headache 46:715–725

    PubMed  Article  Google Scholar 

  13. D’Amico D, Lanteri-Minet M (2006) Migraine preventive therapy: selection of appropriate patients and general principles of management. Expert Rev Neurother 6:1147–1157

    PubMed  Article  Google Scholar 

  14. Diamond ML, Wenzel RG, Nissan GR (2006) Optimizing migraine therapy: evidence-based and patient-centered care. Expert Rev Neurother 6:911–919

    PubMed  Article  CAS  Google Scholar 

  15. Dowson AJ, Sender J, Lipscombe S et al (2003) Establishing principles for migraine management in primary care. Int J Clin Pract 57:493–507

    PubMed  CAS  Google Scholar 

  16. Silberstein SD, Goadsby PJ (2002) Migraine: preventive treatment. Cephalalgia 22:491–512

    PubMed  Article  CAS  Google Scholar 

  17. Loder E, Biondi D (2005) General principles of migraine management: the changing role of prevention. Headache 45(Suppl 1):S33–S47

    PubMed  Article  Google Scholar 

  18. Tepper SJ, D’Amico D, Baos V, Blakeborough P, Dowson AJ (2004) Guidelines for prescribing prophylactic medications for migraine: a survey among headache specialist physicians in different countries. Headache Care 1(4):267–272

    Article  Google Scholar 

  19. Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB (2007) Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study. Headache 47(3):355–363

    PubMed  Google Scholar 

  20. D’Amico D, Solari A, Usai S et al. For the Progetto Cefalee Lombardia Group (2006) Improvement in quality of life and activity limitations in migraine patients after prophylaxis. A prospective longitudinal multicentre study. Cephalalgia 26:691–696

    PubMed  Article  Google Scholar 

  21. Dahlof C, Loder E, Diamond M et al (2007) The impact of migraine prevention on daily activities: a longitudinal and responder analysis from three topiramate placebo-controlled clinical trials. Health Qual Life Outcomes 5(1):56

    PubMed  Article  Google Scholar 

  22. Brandes JL, Kudrow DB, Rothrock JF et al (2006) Assessing the ability of topiramate to improve the daily activities of patients with migraine. Mayo Clin Proc 81(10):1311–1319

    PubMed  Article  CAS  Google Scholar 

  23. Diener HC, Agosti R, Allais G, Bergmans P, Bussone G, Davies B, Ertas M, Lanteri-Minet M, Reuter U, Del Río MS, Schoenen J, Schwalen S, van Oene J, TOPMAT-MIG-303 Investigators Group (2007) Cessation versus continuation of 6-month migraine preventive therapy with topiramate (PROMPT): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 6(12):1054–1062

    PubMed  Article  CAS  Google Scholar 

  24. Meletiche DM, Lofland JH, Young WB (2001) Quality-of-life differences between patients with episodic and transformed migraine. Headache 41:573–578

    PubMed  Article  CAS  Google Scholar 

  25. Bigal ME, Rapoport AM, Lipton RB, Tepper SJ, Sheftell FD (2003) Assessment of migraine disability using the migraine disability assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine. Headache 43:336–342

    PubMed  Article  Google Scholar 

  26. D’Amico D, Grazzi L, Usai S, Rigamonti A, Curone M, Bussone G (2005) Disability pattern in chronic migraine with medication overuse: a comparison with migraine without aura. Headache 45(5):553–560

    PubMed  Article  Google Scholar 

  27. D’Amico D, Leone M, Grazzi L et al (2008) When should “chronic migraine” patients be considered “refractory” to pharmacological prophylaxis? Neurol Sci 29(Suppl 1):S55–S58

    PubMed  Article  Google Scholar 

  28. Scher AI, Stewart WF, Ricci JA et al (2003) Factors associated with the onset remission of chronic daily headache in a population-based study. Pain 106:81–89

    PubMed  Article  CAS  Google Scholar 

  29. Katsarava Z, Schneeweiss S, Kurth T et al (2004) Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology 62:788–790

    PubMed  CAS  Google Scholar 

  30. Limmroth V et al (2007) Topiramate in patients with episodic migraine: reducing the risk for chronic forms of headache. Headache 47(1):13–21

    PubMed  Article  Google Scholar 

  31. Wober C et al (1991) Long-term results of migraine prophylaxis with flunarizine and beta blockers. Cephalalgia 11(6):251–256

    PubMed  Article  CAS  Google Scholar 

  32. Silberstein SD, Collins SD (1999) Safety of divalproex sodium in migraine prophylaxis: an open-label, long-term study. Headache 39(9):633–643

    PubMed  Article  CAS  Google Scholar 

  33. Rapoport A, Mauskop A, Diener HC, Schwalen S, Pfeil J (2006) Long-term migraine prevention with topiramate: open-label extension of pivotal trials. Headache 46(7):1151–1160

    PubMed  Article  Google Scholar 

  34. Manzoni CG, Torelli P (2007) The patient–physician relationship in the approach to therapeutic management. Neurol Sci 28:S130–S133

    PubMed  Article  Google Scholar 

  35. D’Amico D, Tepper SJ (2008) Prophylaxis of migraine: general principles and patient acceptance. Neuropsychiatr Dis Treat 4(6):1155–1167

    PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Author information

Affiliations

  1. Department of Neurology, L. Mandic Hospital, Merate, Lecco, Italy

    F. Moschiano

  2. Headache Centre, Department of Neurological Sciences, C. Besta Neurological Institute, Via Celoria 11, 20133, Milan, Italy

    D. D’Amico & Gennaro Bussone

Authors
  1. F. Moschiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. D’Amico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gennaro Bussone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gennaro Bussone.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Moschiano, F., D’Amico, D. & Bussone, G. Migraine prophylaxis: key points for the practising clinician. Neurol Sci 30, 33–37 (2009). https://doi.org/10.1007/s10072-009-0055-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-009-0055-5

Keywords

  • Migraine
  • Prophylaxis
  • Preventive drugs
  • Guidelines