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Give it time: prophylaxis can spare patients migraine misery.

RANCHO MIRAGE, CALIF.--Patients on a good prophylactic regimen may be spared many of the disabling consequences of migraine attacks, Dr. Thomas N. Ward said at a meeting sponsored by the Diamond Headache Clinic.

They may experience fewer severe manifestations such as basilar migraine, hemiplegic migraine, and migrainous infarction. By allowing some patients to limit their use of short-term migraine therapies to 2 days per week or less, prophylactic therapy may help them avoid analgesic rebound, said Dr. Ward of Dartmouth Medical School, Hanover, N.H.

Preventive regimens for migraines fall into three basic patterns: daily medication used to decrease the frequency of attacks: short-term or "burst" treatment that is taken just before a triggering event such as menses; and intermittent or episodic treatment, also meant to counteract a triggering event, such as changing time zones or traveling at a high altitude.

The most rational way to design a preventive regimen for migraines is to prescribe medication that does not exacerbate the patient's comorbidities or interact with other drugs the patient is taking. For example, meperidine often is prescribed for migraines, but it can be fatal to a patient who also is taking a monoamine oxidase inhibitor, Dr. Ward said.

Start with a low dose of medication and increase it as tolerated and as necessary, but allow at least 3 to 4 weeks to determine if a particular drug or combination of drugs is effective. "In my experience, an adequate drug trial usually requires several months, unless side effects supervene," he said.

Keeping the dosing schedule as simple as possible increases the likelihood of compliance. Have the patient maintain a headache calendar to document the treatment's success, or lack thereof.
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Title Annotation:Clinical Rounds
Author:MacReady, Norra
Publication:Internal Medicine News
Date:Apr 15, 2004
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