Migraine is a chronic neurological disease characterized by attacks of throbbing, often one-sided headache that is aggravated by physical activity and is associated with photophobia, phonophobia, nausea, vomiting and, in many patients, cutaneous allodynia. Of patients develop migraine with an aura that precedes or occurs during some attacks, while about ¾ of patients indicate a prodromal phase before the onset of the headache.
Recommendations on when to start preventive treatment remain unchanged. Migraine patients should be considered for preventive treatment in any of the following situations:
seizures significantly disrupt patients' daily life despite seizure treatment;
frequent attacks (≥4 times a month);
contraindication, failure or overuse of medication during an attack, with overuse defined as:
- ≥10 days per month for ergot derivatives, triptans, opioids, combined analgesics and combinations of drugs of different classes that are not used alone (eg acetaminophen + codeine);
- ≥15 days per month for non-opioid analgesics, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs; including acetylsalicylic acid);
the occurrence of an undesirable phenomenon during treatment;
Prophylaxis should also be given in the management of patients with some of the rare subtypes of migraine, including hemiplegic migraine, migraine with brainstem aura, migraine with prolonged aura, and a history of migraine stroke, even if the frequency of attacks is low.
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