Fast Five Quiz: Migraine Prevention and Treatment

Helmi L. Lutsep, MD


February 04, 2022

Figure 4. Midsaggital view of the brain showing the Trigeminovascular pathway that is activated by an abrupt drop in estrogen.

The following may be considered indications for prophylactic migraine therapy:

  • Migraine variants, such as hemiplegic migraine or rare headache attacks producing profound disruption or risk for permanent neurologic injury

  • Migraine headache days amount to at least two per month with moderate or worse disability

  • The headaches cause major disruptions in the patient's lifestyle

  • Abortive therapy fails or is overused

  • Symptomatic medications are contraindicated or ineffective

  • Use of abortive medications more than twice a week

The goals of preventive therapy include:

  • Reduce attack frequency, severity, and/or duration

  • Improve responsiveness to acute attacks

  • Reduce disability

  • Reduce reliance on suboptimal drug treatments

  • Reduce costs

  • Offer patients a feeling of control and improve health-related quality of life

  • Reduce distress and other psychological problems associated with headache

Learn more about prophylactic migraine therapies.


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