[Prophylactic treatment of migraine]

Because of the outcome of the 5 HT1B/1D agonists or "triptans" for the treatment of migraine attacks, it has been thought that migraine prophylaxis was not useful anymore. However, some patients are not responders to the triptans and some responders who have more than one attack a week still feel the need for prophylactic treatment. Apart from non-pharmacological treatments that are always needed, the different drugs that have shown their efficiency in clinical trials are analysed. The choice of a prophylactic treatment mostly depends on the benefits/risk ratio. In migraine prophylaxis beta-blockers have a good benefits/risk ratio, serotonin receptor antagonists that are effective as well, have a high frequency of adverse effects, especially weight gain and fatigue, which are limiting factors for prescription. In France dihydroergotamine is still largely prescribed because it is well tolerated. Second-line treatments may be considered, they have been studied through clinical trials, they are efficient, but they have severe side effects: flunarizine, sodium valproate and methysergide. The management of all these side effects has to be known, because prophylactic treatment is still necessary for the well-being of migraineurs.