Treatment and management of migraine

A significant percentage of individuals with migraine, by some estimates as many as 25%, are candidates for preventive therapy, also known as prophylactic therapy. These are treatments that are administered to pre-empt headache attacks, as opposed to acute treatments that are administered once a headache attack has occurred (although many treatments may be effective both as preventive and acute therapies). There are a variety of options for preventive therapy with widely varying mechanisms of action, and there is no clear-cut single choice for any individual patient. Preventive therapies can be broadly grouped as antihypertensive medications, anticonvulsant medications, antidepressants, vitamins, natural therapies, neurotoxins, and neuromodulation approaches. Early clinical trials indicate that antibody therapies may play an important role as future migraine preventive therapies. While current therapies are effective for some patients, there is a critical need for better means of identifying which strategy is the best for each individual patient, and also for new approaches that are more effective and better tolerated for prevention of migraine overall.