Treatment and prevention of migraine attack

1. Big picture

Migraine treatment has two separate parts:

1. Acute attack treatment — what the patient takes when the migraine starts.

2. Preventive / prophylactic treatment — regular treatment used to reduce attack frequency, severity, duration, and acute medication use.

The key exam sentence:

Acute migraine treatment should be taken early, at the beginning of the attack, and prophylaxis is considered when attacks are frequent, severe, prolonged, resistant to acute treatment, or disabling.

The classic treatment groups are:

• NSAIDs and aspirin

• Antiemetics

• Ergot derivatives

• Triptans

• Newer acute drugs: gepants and ditans

• Preventive drugs: beta-blockers, calcium-channel blockers, antiepileptics, antidepressants, CGRP-targeting drugs, gepants, magnesium, and trigger management

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