[An overview of prophylactic therapy for migraine]

The launch of triptans has significantly changed the treatment of migraine, leading to great improvement in the quality of life (QOL) of migraine patients. In routine clinical settings, few patients present with migraine attacks that clearly deviate from the typical frequency and severity of migraine, and migraine that is difficult to control with acute-phase treatment alone is frequently encountered. Under these circumstances, the importance of prophylactic therapy, including lifestyle guidance and drug treatment, has attracted attention. However, in Japan, only a small number of prophylactics are currently indicated for migraine, and the available options are insufficient. In this study, I have outlined the prophylactic strategies for migraine, including lifestyle guidance, on the basis of literature published in Europe and North America. In addition, I have presented my clinical experiences and research reports to introduce cases of migraine for which prophylactic therapy was indicated, to hypothesize the mechanisms of the prophylatic activity of specific drugs (e.g., anti-convulsants, anti-depressants, beta-blockers, AII antagonists, Ca channel blockers, leukotriene receptor antagonists, statins, anti-herpes zoster virus drugs) for their prophylactic effect on migraine, and to determine drug regimens.