Current Approaches to the Prophylaxis of Migraine

Migraine is a prevalent and often debilitating condition. Because of this, effective prophylaxis to prevent the recurrence of attacks is an advantageous approach to therapy for some patients. Five main classes of prophylactic agents are currently employed: β-blockers, calcium antagonists, serotonin (5-hydroxytryptamine; 5-HT) modulators, non-steroidal anti-inflammatory drugs and ergot alkaloids. Many variables influence the choice of therapy, including the different characteristics of the available drugs and of each patient. Although β-blockers and flunarizine are generally the most effective prophylactic agents, there is no drug of first-choice and the agent chosen must be carefully tailored to the needs of the individual patient. Status migrainosus — prolonged unresponsive migraine attacks — requires, in most patients, a specific administration protocol consisting of dihydroergot-amine, steroids and phenothiazines.