ABSTRACT
Migraine is a common episodic headache disorder characterized by attacks that consist of various combinations of headache and neurologic, gastrointestinal, and autonomic symptoms. It has a one-year prevalence of approximately 18% in women, 6% in men, and 4% in children (1,2). The second edition of the International Classification of Headache Disorders (ICHD-2) (3) subclassifies migraine into migraine without aura (1.1) and migraine with aura (1.2), the aura being the complex of focal neurologic symptoms that most often precede or accompany an attack (3). Migraine varies widely in its frequency, severity, and impact on the patient’s quality of life. A treatment plan should consider not only the diagnosis, symptoms, and any coexistent or comorbid conditions the patient may have, but also the patient’s expectations, needs, and goals (4). The pharmacologic treatment of migraine may be acute (abortive) or preventive (prophylactic), and patients with frequent severe headaches often require both approaches. Acute treatment attempts to relieve or stop the progression of an attack or the pain and impairment once an attack has begun. It is appropriate for most attacks and should be used for a maximum of two to three days a week. Preventive therapy is given, even in the absence of a headache, in an attempt to reduce the frequency, duration, or severity of attacks. Additional benefits include improving responsiveness to acute attack treatment, improving function, and reducing disability.
