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  • Image not available. Acute migraine therapies should provide consistent, rapid relief and enable the patient to resume normal activities at home, school, or work.
  • Image not available. A stratified care approach, in which the selection of initial treatment is based on headache-related disability and symptom severity, is the preferred treatment strategy for the migraineur.
  • Image not available. Strict adherence to maximum daily and weekly doses of anti-migraine medications is essential.
  • Image not available. Preventive therapy should be considered in the setting of recurring migraines that produce significant disability; frequent attacks requiring symptomatic medication more than twice per week; symptomatic therapies that are ineffective, contraindicated, or produce serious side effects; and uncommon migraine variants that cause profound disruption and/or risk of neurologic injury.
  • Image not available. The selection of an agent for migraine prophylaxis should be based on individual patient response, tolerability, convenience of the drug formulation, and comorbid conditions.
  • Image not available. Each prophylactic medication should be given an adequate therapeutic trial (usually 2–6 months) to judge its efficacy.
  • Image not available. A general wellness program and avoidance of migraine triggers should be included in the management plan.
  • Image not available. After an effective abortive agent and dose have been identified, subsequent treatments should begin with that same regimen.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Discuss factors that precipitate migraine headache and strategies to avoid these factors.
  • 2. List the diagnostic criteria for migraine with aura and migraine without aura as defined by the International Headache Society.
  • 3. Explain the pathophysiologic mechanisms identified with migraine headache.
  • 4. Identify and describe different phases of a migraine attack.
  • 5. List common secondary symptoms that accompany migraine headache.
  • 6. Explain the role of estrogen in migraine headache precipitation and/or aggravation.
  • 7. Discuss the potential danger of medication overuse in headache disorders.
  • 8. State three key actions that are required for relief of a migraine headache.
  • 9. List different factors affecting a patient’s migraine threshold.
  • 10. Differentiate the appropriate use of nonsteroidal antiinflammatory drugs, opiate analgesics, ergot alkaloids, and serotonin receptor agonists (triptans) for the acute treatment of migraine headache.
  • 11. Evaluate the pharmacokinetic and pharmacodynamic profiles of the second-generation triptans compared with sumatriptan.
  • 12. Differentiate between symptomatic (abortive) and preventative (prophylactic) treatment for headache disorders.
  • 13. Recommend appropriate situations for initiation of prophylactic therapy and identify commonly used medications.
  • 14. Identify the differences in clinical presentation of tension and cluster type headaches.
  • 15. Identify signs and symptoms that characterize the clinical presentation of migraine headache.

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Headache is one of the most common complaints encountered by healthcare practitioners and among the top three principal reasons given by adults 18 years of age and older for visiting emergency departments in the United States.1 Headache can be symptomatic of a distinct pathologic process or can occur without an underlying cause. In 2004, the International Headache Society (IHS) updated its classification system and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain2 (Table 70–1...

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