Migraine Prophylaxis

Excerpt

Recurrent migraines can be functionally disabling and can impair quality of life. The disabling nature of migraine headaches leads to frequent visits to outpatient clinics and emergency department facilities, causing significant health and financial burdens. Headaches fall in the top five causes of emergency department visits and the top twenty reasons for outpatient visits. The overall prevalence of migraine headaches is estimated to be 16%; they are more frequent in women, with a sex prevalence ratio of 3:1. Around 38% of patients with episodic migraines would benefit from prophylactic treatment, but only 3% to 13% get it.

After treating acute migraines, all migraine patients should be evaluated for preventive therapy. The purpose of preventive therapy is to decrease the frequency, severity, and duration of migraine attacks. Furthermore, preventative therapy can increase responsiveness to acute migraine therapy and improve the quality of life.

Prophylactic treatment is not curative, and most patients will still need abortive medications for acute migraine. Before starting prophylactic medications, it is imperative to evaluate if patients are using proper and adequate abortive therapies. Overuse of abortive medications can cause rebound headaches.