Immediate and long-term management of migraine headache

Acute episodes: Patients who experience acute episodes of migraine headache can be treated with non-specific antalgics, non-steroidal antiinflammatory drugs, or specific agents, ergot derivatives, triptans. The rationale for specific treatment results from recent advances in OUT understanding of the pathophysiology of migraine. Triptans are serotoninergic agonists. Current recommendations: It is recommended to start with a non-specific agent. This approach is a purely economical attitude based on direct costs (excluding indirect costs). Specific treatment should be initiated immediately in case of failure to avoid self-medication or fatalism. The absence of adapted management can lead to a chronic condition called "transformed migraine" (more than 15 episodes daily) and subsequent abusive use of antalgics. An estimated 1 to 2 million people in France suffer from transformed migraine. Long-term treatment: A large number of long-term strategies are known but should be proposed for selected patients with frequent, invalidating episodes which have an important impact on the patient's quality of life and respond poorly to acute treatment Classically, a long-term treatment should be proposed for patients with more than 2 or 3 severe acute episodes per month. This attitude has been revisited since the advent of specific treatments because a patient who gets rapid relief from specific treatment may not desire a long-term daily regimen. When effective, long-term regimens should be tapered off after about 12 months due to the fluctuating nature of the migraine headache. No valid algorithm predictive of therapeutic response to long-term treatment has been developed. nle choice of the appropriate agent depends on potential side effects and comorbidities.