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Migraine headaches can be very disabling and can cause significant impact on quality of life, including missed work days, reduced productivity, interruption of academic studies, interruption of social activities, and physical discomfort. The American Headache Society (AHS) notes that some people with frequent migraine headaches are at risk for progression to chronic headache and that preventive therapy could alter this progression.

There are several modalities that may be used to help prevent migraine headaches, including:

• Education
• Medication
• Complementary Therapy

Education

Education is important regarding avoidance of triggers and situations that may be conducive to headache onset, such as avoiding triggers, reduce estrogen medication, resting in a dark room when you feel a headache beginning. Just as important are positive behaviors that may help prevent migraine headaches, such as exercising, eating, and sleeping regularly.

Medication

The consensus of the AMPP (American Migraine Prevalence and Prevention) study conducted by the National Headache Foundation suggested the following guidelines for initiation of medication for prevention of migraine headache:

Prevention is recommended for:

• Six or more headache days per month
• Four or more headache days per month with at least some impairment
• Three or more headache days per month with severe impairment or requiring bed rest

Prevention should be considered for:

• Four to five migraine days per month with normal functioning
• Three migraine days per month with some impairment
• Two migraine days per month with severe impairment

No prevention is indicated for the following:

• Less than four headache days per month with no impairment
• No more than one headache day per month even with impairment

According to the U.S. Headache Consortium Guidelines, prevention of migraine headache with drugs should be considered under the following conditions:

• Presence of 2 or more migraine headaches per week or a pattern of increasing attack frequency over time
• Recurring migraines that interfere with daily life despite acute treatment
• Failure of acute treatment, contraindication, or adverse reaction to acute treatment
• Use of medication for acute headache more than twice a week
• Patient preference for preventive treatment

The goals of preventive treatment include:

• Reducing the frequency of headaches by at least 50%
• Reducing the severity and duration of headaches
• Increasing responsiveness to medication for acute headaches
• Increasing quality of life of the patient

Although preventive medication can reduce the frequency of migraine headache by at least 50%, it is estimated that preventive treatment is used by less than 50% of migraine sufferers.

Principles of migraine prevention with medication include:

• Begin with the lowest dose possible and gradually increase until the desired effect is achieved, which may take 2-6 months. Medications should have highest effect and least side effects.
• Patients should understand that a considerable amount of time may lapse until the medications are effective.
• Realistic expectation of the patient regarding success of preventive therapy - i.e. that medication reduces frequency and severity of headaches but does not completely eliminate them. Also, headaches that occur while on preventive treatment can be successfully treated.
• Patients should understand potential side effects of medications and should understand when to contact their physician