Current options for the prevention and treatment of migraine

Background: Migraine is a common condition affecting similar to 18% of wome n and 6% of men in the United States. The goals of managing migraine are 2- fold: to prevent attacks from occurring and to effectively and rapidly end them when they do occur. Objective: This article reviews the acute and prophylactic treatment of mig raine. Methods: Information for inclusion in this review was identified through a search of MEDLINE(R) from 1995 to the present. Search terms included migrai ne, acute treatment, prophylactic treatment, preventive treatment, and indi vidual drug names. Results: Preventive measures for migraine include lifestyle changes (eg, av oiding migraine triggers and maintaining regular sleep, eating, and work ha bits) and drug therapy. Beta-blockers, calcium channel blockers, tricyclic antidepressants, and anticonvulsants are among the more common drug classes used for migraine prophylaxis, but preventive therapy must be individualiz ed, taking into account efficacy, potential adverse effects, coexisting med ical conditions, and drug costs. Many medications are available for the acu te treatment of migraine, including over-the-counter analgesics and prescri ption drugs. Of the latter, the 5-hydroxytryptaminc(1B/1D)-receptor agonist s, or triptans, are the most recently introduced class. Each of the 4 avail able triptans (sumatriptan, zolmitriptan, naratriptan, and rizatriptan) is effective in ending a migraine attack, but comparative trials have shown di fferences between individual drugs in the time to pain relief and the perce ntage of patients who obtain pain relief. Conclusions: Medications to prevent or reduce the frequency of migraine ten d to be less specific and effective than medications for the acute treatmen t of migraine. As a class, triptans are generally well tolerated and may be considered drugs of choice for the acute treatment of moderate to severe m igraine.