Abortive and prophylactic treatment of migraine

Migraine is a common, chronic-intermittent primary headache disorder. Due to their intensity, migraine attacks are usually a cause of intermittent incapacity. The present paper reviews contemporary migraine therapeutic attempts including abortive treatment of attacks and long-term preventive therapy. The aims of abortive treatment are to make the patient headache-free as soon as possible, to reduce associated autonomic symptoms (such as nausea, vomiting, photophobia), and to reduce social disability. Medications used for acute attacks can be divided into nonspecific (acetaminophen, aspirin, nonsteroidal anti-inflammatory agents, and combination analgesics) and specific (triptans, ergotamine). Effective treatment depends on the use of an effective dose as early as possible. Early treatment with specific medications such as triptans is a current approach to migraine therapy and it results in less recurrence of headaches, less need of multiple medications, and fewer side effects. However, a significant number of patients require preventive treatment. The goals of migraine prophylaxis are reduction in frequency and severity of attacks, improvement of the responsiveness of acute attacks to abortive therapy, and improvement of the quality of life. The currently used medications in migraine prevention are beta-adrenergic blockers, antiepileptic agents, antidepressants, and calcium channel blockers. We discuss in the paper the treatment in specific conditions such as menstruation, pregnancy and breast feeding.