with the goal of termination of these symptoms.Preventive therapies are used to reduce attack frequency,
intensity, and duration.5,6 There are a variety of medications
available for both acute and preventive treatment. Some of
these medications are specific for migraine while others are
nonspecific headache or pain medications.
Abortive therapy
There are numerous medications that could be utilized for
acute therapy. The initial choice of abortive medication
should be made based on some important aspects of the
patient’s condition. The best validated method involves the
principle of ‘‘stratified care.’’7 This is a principle in which
treatment is based on the patient’s headache characteristics,
including time of peak intensity, severity of the peak pain,
associated symptoms, and extent of disability, which can be
measured using the Migraine Disability Assessment [MIDAS]
Questionnaire.8 Migraine is not a disorder for which the same
medications will work in every patient, because migraine
severity and accompanying disability can be extremely variable
among patients and even between attacks in the same
patient. The goals of acute treatment, as outlined by the US
Headache Consortium are to treat rapidly and consistently
without recurrence, restore the ability to function, minimize
use of other medications, reduce subsequent use of resources,
and be cost-effective with minimal or no side effects.9
Specific acute treatments for migraine include triptans and
ergots, which by definition are effective in migraine and a
few select primary headache disorders, but in general do not
tend to be effective for other pain disorders.3 The US Headache
Consortium recommends using specific medications for
‘‘mild-to-moderate’’ headaches that do not respond to the
nonspecific medications or migraines that are moderate to
severe in intensity