Pharmacotherapy of Migraine

Introduction

• Migraine — a common, recurrent, often disabling primary headache disorder — attacks of pulsating (throbbing), usually unilateral pain lasting 4–72 h untreated, with nausea/vomiting, photophobia, phonophobia and aggravation by movement. Afflicts ~10–20% of the population (♀ ≈ 20%, ♂ ≈ 10%), peak at 18–44 y.
• Two subtypes — migraine without aura ("common") and migraine with aura ("classic") — reversible focal neurologic (mostly visual) symptoms evolving over ≥5 min, lasting <60 min, preceding/accompanying the headache.
• Attack phases — premonitory (up to 77%, hours–days before) → aura (~25%) → headache → postdrome. Underlies the cardinal rule that acute therapy be started as early as possible, before gastric stasis impairs oral absorption.
• Frequency-based classes — episodic = <15 monthly headache days; chronic = ≥15 days/month for ≥3 months (≥8 migrainous) — drives the acute-vs-preventive decision. Therapy is individualised by attack severity, frequency and prior response.