Migraine preventive medications: a reappraisal

Newer acute care migraine medications demonstrate improved rapidity of acti on, consistent effectiveness, excellent safety profiles, and rarely cause r ebound headaches. Their use could decrease the need for migraine-preventive medication. The present analysis derives a formula that can be used by pra ctitioners to determine the cost-effectiveness of various migraine-preventi ve medications relative to selected acute-care medications. We propose a me asure called the cost-equivalent number (CEN), the number of headaches per month at which the cost of the preventive medication equals the cost saving s in acute-care treatment realized by using the preventive medication. The use of the CEN individualizes the decision of whether to use a migraine-pre ventive medication, weighing both the efficacy and cost of the preventive m edication against the cost of the acute-care medication. A CEN lower than t he migraine frequency suggests that use of a preventive medication will be cost-effective.