Prophylactic Treatments for Migraine

Prophylactic Treatments for Migraine

The role of prevention is to achieve a reduction in the frequency, severity and duration of attacks.  Effective prophylaxis can achieve up to a 50% reduction in the frequency in approximately 50% of migraineurs. Prophylaxis cannot be expected to eliminate migraine completely.

It is thought that while about 50% of all people with migraine are candidates for prophylaxis, only about 10% are actually on a preventative medication.

Indications for Prophylaxis

Prophylaxis is indicated in patients who:

  • Experience two or more attacks per month and do not respond satisfactorily to acute therapy
  • Suffer from concomitant co-morbidities
  • Suffer from a medical illness precluding first line acute therapy
  • Suffer attacks that significantly interfere with the patients daily routine
  • Demonstrate regular patterns to their attacks
  • Experience long duration attacks
  • Have Basilar or Hemiplegic migraine
  • Are at risk of Medication induced headache from over use of acute treatments.

Mode of Action of Prophylactic Agents

The preventative therapies are thought to mediate their benefit by antagonism of central serotonergic receptors, by regulation of calcium ion channels, and by enhancement of central antinociceptive mechanisms.  This results in raising the threshold for both cortical spreading depression and trigeminovascular activation.

Prophylactic Treatments for Migraine

Prophylactic Treatments for Migraine

The role of prevention is to achieve a reduction in the frequency, severity and duration of attacks.  Effective prophylaxis can achieve up to a 50% reduction in the frequency in approximately 50% of migraineurs. Prophylaxis cannot be expected to eliminate migraine completely.

It is thought that while about 50% of all people with migraine are candidates for prophylaxis, only about 10% are actually on a preventative medication.

Indications for Prophylaxis

Prophylaxis is indicated in patients who:

  • Experience two or more attacks per month and do not respond satisfactorily to acute therapy
  • Suffer from concomitant co-morbidities
  • Suffer from a medical illness precluding first line acute therapy
  • Suffer attacks that significantly interfere with the patients daily routine
  • Demonstrate regular patterns to their attacks
  • Experience long duration attacks
  • Have Basilar or Hemiplegic migraine
  • Are at risk of Medication induced headache from over use of acute treatments.

Mode of Action of Prophylactic Agents

The preventative therapies are thought to mediate their benefit by antagonism of central serotonergic receptors, by regulation of calcium ion channels, and by enhancement of central antinociceptive mechanisms.  This results in raising the threshold for both cortical spreading depression and trigeminovascular activation.