Anatomy of a Headache

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Long-Acting Opioids for
Refractory Chronic
Migraine

Study results for a group
of difficult-to-treat
migraineurs provide a
basis for determining
efficacy and guidelines
for the use of long-term
opioids in this
population.

 

Heatherís Chronic
Migraine: an Interactive
Case History

This column will take you,
step by step, through
the diagnosis of a complex
headache patient with
the pseudonym of "Heather."

 

ROBBINS HEADACHE CLINIC

60 Revere Drive, Suite 330, Northbrook, IL 60062
Phone: 847-480-9399

Title:
Preventive Migraine Treatment
Author:
Silberstein, SD2009
Date:
Posted: Change Date Here!
Source:
Jefferson University  2009 May;27(2):429-43

The pharmacologic treatment of migraine may be acute (abortive) or preventive (prophylactic), and patients with frequent severe headaches often require both approaches. Preventive therapy is used to try to reduce the frequency, duration, or severity of attacks. The preventive medications with the best-documented efficacy are amitriptyline, divalproex, topiramate, and the beta-blockers. Choice is made based on a drug's proven efficacy, the physician's informed belief about medications not yet evaluated in controlled trials, the drug's adverse events, the patient's preferences and headache profile, and the presence or absence of coexisting disorders. Because comorbid medical and psychologic illnesses are prevalent in patients who have migraine, one must consider comorbidity when choosing preventive drugs. Drug therapy may be beneficial for both disorders; however, it is also a potential confounder of optimal treatment of either.

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