Drug prophylaxis for migraine headaches.

Abstract

Drug prophylaxis of migraine headaches is not indicated for all patients; however, it may be useful for patients who experience considerable disruption of their daily lives because of migraine attacks. To be most effective, drug prophylaxis should be one component of a comprehensive approach that includes avoidance of precipitating factors, improvement in coping skills and, for most patients, increased exercise. The prophylaxis regimen should be individually tailored for each patient. Both physician and patient need to determine whether the benefit of prophylaxis outweighs the inconvenience and possible side effects of the medication used. Beta-adrenergic blocking drugs, notably propranolol, are most frequently chosen for prophylaxis. Other effective agents include tricyclic antidepressants, calcium channel blockers and nonsteroidal antiinflammatory agents, particularly naproxen.