J Korean Med Assoc.
2020 Oct;63(10):644-649. 10.5124/jkma.2020.63.10.644.
Pharmacotherapy of migraine prevention based on the assessment of headache
- Affiliations
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- 1Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
- KMID: 2508749
- DOI: http://doi.org/10.5124/jkma.2020.63.10.644
Abstract
- Migraine as a recurrent, relapsing, and chronic disease is one of the most disabling disorders globally. Most patients are women in their reproductive age and their migraines are classified as episodic migraine. Although less than half of the episodic and most chronic migraineurs require preventive intervention, early discontinuation rates are high, owing to poor tolerability and insufficient awareness about migraine. This article aims to review the recent update of migraine prevention based on the practice guidelines for the prevention of episodic migraine published by the Korea Headache Society and the position statement of the American Headache Society in 2019. The goal of migraine prevention is to reduce migraine attack frequency by at least 50 %, the number of migraine days, and the attack severity to ultimately improve quality of life. The guidelines recommend considering the initiation of preventive medication when recurring migraines significantly interfere with daily life or when acute treatment is contraindicated or inappropriate. Preventive medications should be determined based on various qualified assessments. Pharmacologic treatments are recommended for migraine prophylaxis include antidepressant (amitriptyline), anti-epileptic drugs (topiramate, divalproex sodium), beta-blockers (propranolol, metoprolol), calcium channel blocker (flunarizine), and intramuscular injection of onabotulinumtoxin A. Furthermore subcutaneous or intravenous injection of calcitonin gene-related peptide monoclonal antibodies was recently approved as a new therapy for migraine prevention. Migraine is a chronic debilitating disorder. The initiation of evidence-based preventive management is necessary and management methods should be individually selected to improve quality of life.
