Appropriate and effective treatment for migraine first assumes an accurate diagnosis. In general, the treatment of migraine may be divided into two general pharmacologic approaches: treatment of the acute attack (abortive, symptomatic) or preventative (prophylactic ) therapy aimed at preventing the recurrence of headache. Patients often may need both treatments if their headaches are frequent and severe. Symptomatic treatment is appropriate for most acute attacks and should be used a maximum of two to three days per week. If attacks occur more frequently, treatment strategy should emphasize decreasing attack frequency with prophylactic medications.

Medications used in acute headache treatment include analgesics, antiemetics, anxiolytics, nonsteroidal anti-inflammatory drugs (NSAIDs), ergots, steroids, major tranquillizers, narcotics, and more recently the selective 5HT1 (serotonin) agonists such as IMITREX, MAXALT and ZOMIG. Preventive therapy includes a broad range of medications most notably calcium channel blockers, beta blockers, antidepressants, serotonin antagonists, and anticonvulsants including Depakote and Topamax.  BOTOX injections may be very useful in patient with a strong muscle contraction component.

 

 

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