Treatment of migraine headaches.

Migraine headaches are common and costly. Patients with migraine frequently seek medical attention from primary care physicians. Although effective therapy is available, migraine is underdiagnosed and undertreated. The 3 main forms of management are avoidance of migraine triggers, treatment of the acute attack with medications, and regular use of preventive medications. Although changes in lifestyle can help to prevent some migraine attacks, the mainstay of treatment is the use of medications taken early during the attack. A wide variety of single-ingredient and combination over-the-counter and prescription medications are now available. Especially effective are the new selective serotonin (5-hydroxytryptamine1 receptor) agonists such as sumatriptan. For patients who have frequent and severe migraine headaches despite the use of acute treatment, preventive medications, including beta-adrenergic blockers, calcium channel blockers, tricyclic antidepressants, and one anticonvulsant, should be considered. The vast majority of patients with migraine can be helped.