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Acute and Preventive Treatment of Migraine

Rizzoli, Paul, B.

CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache - p 764–782
doi: 10.1212/01.CON.0000418641.45522.3b
Review Articles

Purpose of Review: Migraine remains underdiagnosed and undertreated despite advances in the understanding of its pathophysiology and management. This article focuses on acute and preventive treatment of migraine, including the mechanisms of action, dosing and side effects of medications, and strategies for the most effective care.

Recent Findings: Best practice suggests that acute migraine treatment should be stratified based on the severity of the individual event, with a goal of returning the patient to full function within 2 hours of treatment. Migraine prevention strategies continue to be underused in the United States. More than 1 in 4 patients with migraines may be candidates for preventive therapy. To obtain the best results from preventive therapy, slow titration to an adequate dose for an adequate timeframe with good documentation of the results is recommended.

Summary: This article reviews several options for managing acute attacks, including information on expected efficacy, dosing, and adverse effects. Strategies for effective application of acute therapies are discussed. Prevention can be added to acute therapy depending on headache characteristics such as frequency, severity, disability, and the presence of comorbid conditions. The mechanisms of action of preventive medications and strategies for their most effective use are discussed.

Address correspondence to Dr Paul B. Rizzoli, BW/Faulkner Neurology, John R. Graham Headache Center, 1153 Centre St, Suite 4970, Jamaica Plain, MA 02130,

Relationship Disclosure: Dr Rizzoli served on a Zogenix, Inc., advisory board in 2010 and has performed legal record review in expert testimony.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rizzoli discusses the unlabeled use of medications in the acute and preventive treatment of migraine. Unlabeled use of these medications is disclosed in the article.

© 2012 American Academy of Neurology
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