Migraine throughout the life cycle: treatment through the ages

Migraine seriously impairs the quality of life in those who suffer from it and exacts a high socioeconomic cost in lost productivity. About half of all persons with migraine go undiagnosed. To avoid misdiagnosis of migraine, clinicians must be prepared to recognize atypical presentations, including tension headache-like and "sinus" symptoms. Nonpharmacologic treatments, including relaxation training and thermal or EMG biofeedback training, may be appropriate for some patients. Pharmacotherapy for migraine may be acute or preventive. In prescribing treatment, the clinician should consider the characteristics of the patient's headaches, the patient's medication history and preferences, and co-morbidities. For acute treatment in patients with more severe migraine and those whose headaches respond poorly to nonsteroidal anti-inflammatory drugs or combination analgesics, migraine-specific agents, such as triptans, dihydroergotamine, and ergotamine, are recommended. Early intervention--identifying and treating the headache during the mild phase--is often a key to successful management. Preventive treatment of migraine may be appropriate to reduce the frequency, severity, and duration of migraine attacks, to improve the response to acute treatment, and to reduce disability. Clinicians who treat migraine must be aware of considerations specific to children, women, and the elderly.