Treatment strategies in the acute therapy of migraine: Stratified care and early intervention

D. D'Amico, F. Moschiano, S. Usai, G. Bussone

Research output: Contribution to journalArticlepeer-review


Various treatment strategies have been proposed to help clinicians provide the most effective acute treatment for migraine patients. Stratified care is based on the concept that the most appropriate initial treatment can be prescribed after evaluation of each patient's headache characteristics. The results of a large multicentre trial showed that when patients were stratified according to disability grade, clinical outcomes were significantly better than with step-care approaches. Prospective studies have shown that treating migraines with triptans when pain is mild (early intervention) considerably increases success rates for endpoints (pain-free at 2 h, sustained pain-free state) for which triptans had relatively poor efficacy in pivotal trials, and which contribute most to patient satisfaction. Stratified care and early treatment are also cost-effective. However these strategies are not suitable for all patients. Stratified care may be rendered difficult by medication contraindications and changes in attack characteristics over time. Early triptan intervention carries a risk of medication overuse and might not be indicated in patients with lack of pain progression. Successful implementation of both strategies requires that physicians are well informed, and that they elicit an exhaustive headache history from each patient.

Original languageEnglish
JournalNeurological Sciences
Issue numberSUPPL. 2
Publication statusPublished - Sep 2006


  • Acute treatment
  • Early intervention
  • Migraine
  • Stratified care
  • Treatment strategies

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


Dive into the research topics of 'Treatment strategies in the acute therapy of migraine: Stratified care and early intervention'. Together they form a unique fingerprint.

Cite this