Skill Checkup: A 20-Year-Old Woman With a Diffuse Pulsatile Headache, Neck Pain, and Nausea

Helmi L. Lutsep, MD


February 10, 2022

Generally, patients should be advised to limit medication use to an average of 2 headache days per week, and those who feel it necessary to exceed this limit should be offered a preventive treatment. Patients with migraine variants are candidates for prophylactic therapy, such as those with hemiplegic migraine, migraine with brainstem aura, migraine with prolonged aura, and those who have previously experienced a migrainous infarction. Other indications for preventive treatment include: use of abortive medications more than twice a week; at least 2 migraine headache days per month, causing moderate or worse disability; abortive therapy fails or is overused; symptomatic medications are contraindicated or ineffective; or headaches significantly disrupt the patient's life.

CGRP antagonists were the first drugs developed specifically for migraine prevention in adults. They are delivered by injection or, in the case of eptinezumab-jjmr, by infusion, either every month or every 3 months. Ubrogepant is the first CGRP approved for the acute treatment of migraine. Rimegepant is another recently approved oral CGRP antagonist for acute treatment.


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