Current options for the prevention and treatment of migraine

Migraine is a common condition affecting approximately 18% of women and 6% of men in the United States. The goals of managing migraine are 2-fold: to prevent attacks from occurring and to effectively and rapidly end them when they do occur.

This article reviews the acute and prophylactic treatment of migraine.

Information for inclusion in this review was identified through a search of MEDLINE from 1995 to the present. Search terms included migraine, acute treatment, prophylactic treatment, preventive treatment, and individual drug names.

Preventive measures for migraine include lifestyle changes (eg, avoiding migraine triggers and maintaining regular sleep, eating, and work habits) and drug therapy. Beta-blockers, calcium channel blockers, tricyclic antidepressants, and anticonvulsants are among the more common drug classes used for migraine prophylaxis, but preventive therapy must be individualized, taking into account efficacy, potential adverse effects, co-existing medical conditions, and drug costs. Many medications are available for the acute treatment of migraine, including over-the-counter analgesics and prescription drugs. Of the latter, the 5-hydroxytryptamine(1B/1D)-receptor agonists, or triptans, are the most recently introduced class. Each of the 4 available triptans (sumatriptan, zolmitriptan, naratriptan, and rizatriptan) is effective in ending a migraine attack, but comparative trials have shown differences between individual drugs in the time to pain relief and the percentage of patients who obtain pain relief.

Medications to prevent or reduce the frequency of migraine tend to be less specific and effective than medications for the acute treatment of migraine. As a class, triptans are generally well tolerated and may be considered drugs of choice for the acute treatment of moderate to severe migraine.