Therapy of migraine

Migraine therapy includes avoidance of trigger factors, non-pharmacological and complementary therapies and pharmacological therapy, i.e. Symptomatic (or acute) treatment and prophylaxis (or migraine prevention). Several drugs potentially effective for both of these pharmacological approaches are available, which should be prescribed considering scientific evidence (as reported in international guidelines) as well as migraine features and personal characteristics of the individual patient. Triptans and some NSAIDS are the most useful drugs to relieve migraine attacks. Topiramate, sodium valproate/divalproex, propranolol, amitriptyline, flunarizine, and venlafaxine are among the possible choices for prophylaxis, depending on the patient’s characteristics. The main data on efficacy and tolerability of the different suggested drugs are briefly reviewed, as well as the main strategies which should inform a treatment plan in the individual migraine patient. Some notes on the treatment of paediatric migraine are included.