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Considerations for tailored treatment decisions for migraine.1

  • Headache frequency
  • Level of disability caused by migraine
  • Presence of specific migraine forms
  • Previous treatments
  • Comorbid conditions
  • Potential drug interactions

 

People with headaches may benefit from using a diary to record the frequency, duration and severity of headaches, to monitor the efficacy of interventions and as a tool to facilitate discussions on the impact of migraines on their life.2


Migraine treatment objectives may include:1

 

  • Relieving symptoms
  • Restoring function
  • Reducing headache frequency and severity
  • Reducing migraine-related disability
  • Preventing disease progression
  • Managing comorbidities, including risk of stroke, depression, anxiety, sleep disorders and other pain conditions

Medical treatments

There are a number of different treatment options available for patients with migraine.

Guidelines recommend further research into psychological interventions for migraine, such as cognitive behavioural therapy, and suggest that physical therapy may be beneficial to some migraine sufferers.2,5

In patients with a menstrual-related migraine, other pharmacological ‘mini-preventive’ interventions are available for a predictable cycle.13 In those who do not respond to acute oral treatments, non-oral preparations of triptan, NSAID, metoclopramide or prochlorperazine may be offered.2


 

Treatment options

 Preventative treatment table

 

* Not indicated for migraine in Australia 

 

Risk of migraine progression

Migraine may progress to greater severity, frequency, duration and disability over time.8 The potential for disease progression makes regular assessment and treatment evaluation an important part of migraine care.
Three or more headache days per month increases risk of disease progression.9

 

Lifestyle modifications

When managing migraine considering the impact of the following features may help improve patient outcomes8, 11, 12

  • Sleep
  • Nutrition/Hydration
  • Active Living/Exercise
  • Trigger Avoidance
  • Stress management

 

 

References


    1. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55(6): 754–762

    2. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline 150. September 2012 (updated 2015)

    3. Charles A, Pozo-Rosich P. Targeting calcitonin gene-related peptide: a new era in migraine therapy. Lancet 2019; 9; 394(10210):1765-1774;

    4. Antonaci F et al. A review of current European treatment guidelines for migraine. J Headache Pain 2010; 11: 13–19

    5. British Association for the Study of Headache. Guidelines for all healthcare professionals in the diagnosis and management of Migraine. 3rd edition. September 2010

    6. National Institute for Health and Care Excellence. Botulinum toxin type A for the prevention of headaches in adults with chronic migraine. Technology appraisal guidance 260. June 2012

    7. National Institute for Health and Care Excellence. Transcranial magnetic stimulation for treating and preventing migraine. Interventional procedures guidance IPG477. January 2014

    8. Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache 2015; 55 (Suppl 2): 103–122

    9. Bigal ME, Lipton RB. Clinical course in migraine: conceptualizing migraine transformation. Neurology 2008; 71(11): 838–855

    10. Bigal ME, Lipton RB. Overuse of acute migraine medications and migraine chronification. Curr Pain Headache Rep 2009; 13: 301–307

    11. American Migraine foundation. Headache Hygiene - What is it? 2016 Available at: https://americanmigrainefoundation.org/understanding-migraine/headache-hygiene-what-is-it/ (last accessed September 2018)

    12. Al-kotb H and Ibrahim MH. American Journal of Nursing Science 2016;5:280–287

    13. Ray, J. et al The state of migraine: An update on current and emerging treatments, Australian Journal for General Practitioners 2021; 50: 915-921]