Migraine, an episodic headache disorder, is one of the most common complaints encountered
by primary-care physicians and neurologists. Nevertheless, it remains underdiagnosed
and undertreated. Rational migraine treatment necessitates an accurate diagnosis,
identification and removal of potential triggering factors, and, frequently, pharmacologie
intervention. Effective management also includes establishing realistic expectations,
patient reassurance, and education. The choice of medication (abortive, symptomatic)
for an acute attack depends on such factors as the severity of the attack, presence
or absence of vomiting, time of onset to peak pain, rate of bioavailability of the
drug, comorbid medical conditions, and side-effect profile. Effective agents for acute
attacks include simple or combination analgesics, nonsteroidal anti-inflammatory drugs,
ergot derivatives, selective serotonin agonists, and antiemetics. Opioid analgesics
are unnecessary for most patients. The choice of preventive (prophylactic, interval)
medication depends primarily on comorbid medical conditions and side-effect profile.
Useful preventive agents include ß-adrenergic blockers, calcium channel blockers,
tricyclic antide-pressants, anticonvulsant medications, and serotonin antagonists.
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© 1996 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
