Management of migraine

An algorithmic approach

S. D. Silberstein, P. J. Goadsby, Richard B. Lipton

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Good management of migraine requires that the patient participate actively in decisions regarding therapeutic intervention. Most patients, when carefully informed, will engage in a wellness program that includes regular exercise and rest, good nutrition, and avoidance of headache triggers. Acute treatment is probably most likely to be beneficial if it is started early in the migraine attack. Headache severity and associated features, such as nausea, vomiting, or previous treatment responses, can guide selection of medication for acute treatment. Simple analgesics or nonsteroidal anti-inflammatory drugs, with or without antiemetics, are usually the first line of treatment and are effective for some attacks. Combination analgesics or ergotamine preparations represent second-line therapies for patients with infrequent attacks. For patients unlikely to respond to simpler treatments, 5-HT(1B/1D) receptor agonists or dihydroergotamine offer the best chance for relief. Narcotic analgesics may be needed when other antimigraine drugs prove ineffective, but must be prescribed judiciously. Patients with 3 or more days of headache-related disability per month, or with headaches refractory to acute treatment, are candidates for preventive therapy. Coexisting disease can contribute to decisions on prophylaxis. In many cases, a single agent may be used to treat both migraine and a coexisting disorder. β-blockers are most often used for preventive therapy. Other options include divalproex, antidepressants, calcium-channel antagonists, serotonin antagonists, and riboflavin.

Original languageEnglish (US)
JournalNeurology
Volume55
Issue number9 SUPPL. 2
StatePublished - 2000
Externally publishedYes

Fingerprint

Migraine Disorders
Headache
Therapeutics
Analgesics
Receptor, Serotonin, 5-HT1D
Dihydroergotamine
Ergotamine
Receptor, Serotonin, 5-HT1B
Serotonin Antagonists
Antiemetics
Riboflavin
Narcotics
Calcium Channel Blockers
Valproic Acid
Health Promotion
Pharmaceutical Preparations
Nausea
Antidepressive Agents
Vomiting
Anti-Inflammatory Agents

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Silberstein, S. D., Goadsby, P. J., & Lipton, R. B. (2000). Management of migraine: An algorithmic approach. Neurology, 55(9 SUPPL. 2).

Management of migraine : An algorithmic approach. / Silberstein, S. D.; Goadsby, P. J.; Lipton, Richard B.

In: Neurology, Vol. 55, No. 9 SUPPL. 2, 2000.

Research output: Contribution to journalArticle

Silberstein, SD, Goadsby, PJ & Lipton, RB 2000, 'Management of migraine: An algorithmic approach', Neurology, vol. 55, no. 9 SUPPL. 2.
Silberstein SD, Goadsby PJ, Lipton RB. Management of migraine: An algorithmic approach. Neurology. 2000;55(9 SUPPL. 2).
Silberstein, S. D. ; Goadsby, P. J. ; Lipton, Richard B. / Management of migraine : An algorithmic approach. In: Neurology. 2000 ; Vol. 55, No. 9 SUPPL. 2.
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