Multidisciplinary Approach

Every patient should be screened to determine whether they are a candidate for acute and preventive management of migraine. It is important to take a multidisciplinary view of migraine management, as many patients require lifestyle changes and behavioral therapy in addition to pharmacological options.10

Lifestyle Modifications

  • sleep icon
    Sleep
  • stress management icon
    Stress
    Management
  • nutrition/hydration icon
    Nutrition/
    Hydration
  • active living/exercise icon
    Active Living/
    Exercise
  • trigger avoidance icon
    Trigger
    Avoidance

Medical Treatments

  • Pharmacological

    Preventive

    Non-migraine specific
    medications

    • Vitamins & Supplements
    • Anti-epileptics
    • Betablockers
  • Behavioral

    Preventive

    • Behavioral therapy
    • Relaxation
    • Bio-feedback
  • Interventional

    Preventive

    • Neurotoxins
    • Trigger points
    • Nerve block
    • Non-invasive nerve
      stimulation/modulation
      devices

Other medications, such as certain calcium-channel blockers, antidepressants and serotonin antagonists, are also commonly used.10,25,26,27

You may find it helpful to review the treatment guidelines from the American Academy of Neurology and the American Headache Society, which were created after the 2012 review of the evidence relative to the efficacy of various medications for migraine prevention.

Guideline update from AAN/AHS on pharmacologic treatment for migraine prevention
  • Pharmacological

    Acute Attack Relief

    Non-migraine specific medications

    • Anti-epileptics
    • Corticosteroids
    • Isometheptene &
      isometheptene
      combination agents
    • NSAIDs, analgesics &
      combination analgesics

    Migraine-specific medications

    • Triptans
    • Ergot alkaloids &
      derivatives
  • Behavioral

    Acute Attack Relief

    • Behavioral therapy
    • Relaxation
    • Bio-feedback
  • Interventional

    Acute Attack Relief

    • Devices

Treatment Objectives & Considerations

Migraine treatment objectives may include:10

  • Relieving symptoms
  • Restoring function
  • Reducing headache frequency and severity
  • Reducing migraine-related disability
  • Preventing disease progression
  • Management of comorbidities including risk of stroke, depression, anxiety, sleep disorders and other pain conditions

 

Considerations for tailored treatment decisions for migraine include:10

  • Headache frequency
  • Level of disability caused by migraine
  • Presence of specific migraine forms
  • Previous treatment history
  • Individual patient considerations
  • Comorbid conditions
  • Potential drug interactions

Risk of Migraine Progression

Migraine may progress to greater severity, frequency, duration and disability over time.11 The potential for disease progression makes continual assessment and treatment evaluation an important part of migraine care.

  • 4 or more headache days per month increases risk of disease progression

    4 or more headache days per month increases risk of disease progression12

  • inadequate management of acute migraine attacks can double the risk of progression

    Inadequate management of acute migraine attacks can double the risk of progression13

Go to Preventive Treatment