PHARMACOLOGICAL PREVENTION OF MIGRAINE

Although abortive treatment and nonpharmacologic interventions are eff ective for many if not most patients' occasional migraine attacks, pat ients who have frequent and/or severe attacks may benefit from prevent ive pharmacotherapy. This is particularly critical for those patients whose migraines are not treated effectively by acute-care medications because lack of pain control may lead to overuse syndromes that compli cate further treatment. Inappropriate use of acute-care medication may contribute to chronic daily headache, tolerance to symptomatic medica tion, and headache refractory to all treatment. In addition, patients who increase use of acute-care medication due to lack of effect may su ffer ergotism, GI problems, liver toxicity, analgesic nephropathy, dru g induced-headache, and withdrawal symptoms when overused agents are w ithdrawn. Finally overuse of acute-care medication may interfere with the effectiveness of preventive medication. The remainder of this arti cle will focus on when to treat with preventive medication and which m edications are currently available for prevention of migraine. (C) 199 8 Wiley-Liss, Inc.