Preventive Pharmacotherapy in Migraine
Paul Rizzoli, MD
Migraine prevention can be instrumental in the effective management of the migraine patient but remains underused in
treatment of this common, chronic, and often debilitating condition. The development of methysergide as the first migraine
preventive agent not only laid the groundwork for our current thinking about migraine prevention, but also created a paradigm
shift away from migraine as a psychological issue and toward migraine as a legitimate medical condition.
This short review is intended to help the reader select patients appropriate for prevention and to initiate, monitor, and
adjust preventive treatment. Goals in discussing preventive management are to facilitate provider familiarity with and confidence
in this therapy leading to improved clinical outcomes and to a reduced burden of headache-related disability. Optimal
therapeutic success is best achieved in the setting of a strong therapeutic alliance. Medication options for prevention are
reviewed. Continued educational efforts directed at both patient and provider may be required to improve treatment utilization
and reduce headache impact.
Preventive Pharmacotherapy in MigrainePaul Rizzoli, MDMigraine prevention can be instrumental in the effective management of the migraine patient but remains underused intreatment of this common, chronic, and often debilitating condition. The development of methysergide as the first migrainepreventive agent not only laid the groundwork for our current thinking about migraine prevention, but also created a paradigmshift away from migraine as a psychological issue and toward migraine as a legitimate medical condition.This short review is intended to help the reader select patients appropriate for prevention and to initiate, monitor, andadjust preventive treatment. Goals in discussing preventive management are to facilitate provider familiarity with and confidencein this therapy leading to improved clinical outcomes and to a reduced burden of headache-related disability. Optimaltherapeutic success is best achieved in the setting of a strong therapeutic alliance. Medication options for prevention arereviewed. Continued educational efforts directed at both patient and provider may be required to improve treatment utilizationand reduce headache impact.
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