Migraine Prevention Strategies Underused

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Migraine Prevention Strategies Underused

Migraine headache causes severe head pain that is often accompanied by sensitivity to light, sound or any sharp smell. It is different from other types of headache and often involves only one side of the head, but some patients can affect both sides. Moreover, it may be accompanied by nausea or vomiting as well.  While cluster headaches are very severe headaches affecting one side of the head continually. There are few strategies that can substantially improves the quality of life for patients with continuous migraine.

Data from the Acute Migraine Prevalence and Prevention study indicated that almost a fourth patient with regular headache receives a preventive treatment. Patients which suffered from continuous headaches have a significantly greater risk of transformation to chronic daily headache (CDH) which reinforced the potential value for using the preventive strategies.

Although, the definition of “frequent headache” varies by clinician and the patient, the evidence suggests that the risk of CDH begins with the increased headache frequency(once in a week). Moreover, other parameters considered was when the acute medications do not work or when there is contraindication to them.

Development of the impressive prevention strategy which starts with the communicating clearly the goals of the treatment to the patient. Burch stated that “The goal is not no headaches”. The objectives were to decrease the frequency, intensity and duration of episodes; improves the responsiveness to acute treatment, improves the function and reduces the need for acute treatment. Patient cooperation and compliance was one of the most problematic aspects of the preventive therapy. However, one of the recent study showed the 6-month adherence rate less than 30% and 12-month rateless than 20%, irrespective of how adherence was defined.

It was observed that the preventive treatment should be optimized on the basis of objective evidence, such as the effect of treatment on headache frequency and severity, but medication which was used should also be monitored. Practitioner wanted the more granular information to be added to the disability and quality of life measures to the assessment, as well as the missed work days and emergency department visits.

The Food and Drug Administration (FDA) has approved an onabotulinum toxin A to treat chronic migraine. Some evidences also supported the use of topiramate, but it does not have FDA approved indication for chronic migraine. Burch said that, “Migraine prevention has remained an imprecise and associated with the multiple conundrums”. Some included the duration of the treatment, true distinctions between the preventive and acute treatments, real improvement versus regression to the mean and future strategies for evaluating the potential preventive treatments.


Burch R, et al "Preventive treatment of migraine" SHS 2016; Headache 101.

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Original title of article:

SHS: Migraine Prevention Strategies Underused


Charles Bankhead

Burch R, et al "Preventive treatment of migraine" SHS 2016; Headache 101.
Exploratory, Migraine, Chronic, Review, Preventive therapy
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