Pharmacologic Options for the Management and Prevention of Migraines

Abstract

Objective: To review available pharmacologic options for the management and prevention of migraine headaches. Data Sources: A PubMed literature search (1985–December 2010) was conducted using the following MeSH search terms: migraine, aura, headache, triptans, ergot derivatives, NSAIDs, opioids, analgesics, antiepileptics, antidepressants, β-blockers, calcium channel blockers, and prophylaxis. Tertiary references and prescribing information for included medications were used for dosing recommendations. Study Selection and Data Extraction: English-language reviews, tertiary references, guidelines, and clinical trials of newly released medications were reviewed for inclusion. Articles using pharmacotherapy in human models were reviewed. Data Synthesis: Migraine headaches are a costly and painful problem that affects 12% of the US population. Current treatment options may be divided into either acute treatments or preventive therapy. Nonpharmacologic therapy, such as the identification of triggers and maintenance of a headache diary, is an important addition to either medication regimen. Patients experiencing mild-to-moderate migraine pain may be able to manage the pain using nonsteroidal antiinflammatory drugs or analgesics. More severe migraine pain may require the use of different medications, such as opioid pain relievers or a triptan. Patients who report frequent migraines or migraines that significantly affect their activities of daily life may become candidates for migraine prophylaxis. Agents for migraine prophylaxis include antiepileptics, β-adrenergic antagonists, antidepressants, and calcium channel blockers. Conclusions: There are several options available for both the management and prevention of migraine headaches. Choice of pharmacotherapy depends on the intensity and frequency of a patient's migraines. In addition, patients should be encouraged to avoid triggers and to keep a log of migraine symptoms in order to best manage their migraines.