Summary in 3 tables: How to choose medicine to treat migraine?

Migraine is a common neurological disease characterized by recurrent headaches, usually accompanied by a series of symptoms, including nausea, vomiting, and sensitivity to light or sound. Long-term migraines can easily cause comorbidities such as anxiety and depression.

According to the "Guidelines for the Diagnosis and Treatment of Migraine in China (2022 Edition)", the clinical treatment of migraine is recommended to adopt a hierarchical diagnosis and treatment. Internal medicine or general practitioners in primary or primary medical institutions are responsible for the initiation and maintenance of treatment for migraine patients . Migraine patients who are difficult to diagnose and treat can be referred to headache clinics (centers) for further diagnosis and treatment by headache specialists.

Generally speaking, migraine cannot be cured, but medications can be used to prevent pain attacks, relieve pain, and reduce the frequency and severity of pain attacks. Therefore, standardized drug treatment of migraine is crucial.

Migraine, how to give medicine in the acute phase?

According to the "Guidelines for the Diagnosis and Treatment of Migraine in China (2022 Edition)", in principle, the following is recommended: - Mild to moderate migraine: non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.

For patients with moderate to severe migraine or those who do not respond well to nonsteroidal anti-inflammatory drugs, caffeine-containing combination preparations (such as aspirin + acetaminophen + caffeine) or migraine-specific drugs (such as triptans) can be used.

It is important to note that: (1) Regardless of the type of acute treatment chosen, it should be started at the early stage of the headache to improve the effectiveness of the treatment and reduce the impact on life, work, study and society. (2) When taking medications during the acute phase, care should be taken to avoid overuse of medications. The acute medications that are prone to medication overuse headache and their frequency of use are usually:

① Nonsteroidal anti-inflammatory drugs are used for more than 15 days per month;

② Triptans are used for more than 10 days per month;

③ Opioid use for more than 10 days per month;

④ Caffeine-containing compound preparations are used for more than 10 days per month.

Acute treatment recommendations and evaluation (see Table 1)

Migraine, how to prevent medication?

Preventive treatment can be considered for frequent migraine attacks, which is beneficial to change the patient's lifestyle and health status. The specific indications for preventive drug treatment are as follows (see Table 2):

It should be noted that before using preventive treatment drugs, it is necessary to fully communicate with the patient and select them according to the individual situation of the patient, paying attention to the therapeutic effect and adverse reactions of the drug, and taking into account the patient's comorbidities, interactions with other drugs, daily medication times and economic conditions. Usually, strongly recommended drugs with clear evidence are considered first.

Preventive treatment evaluation and recommendations (see Table 3)

Migraine is a disease that cannot be cured at present but can be effectively controlled. In addition to drug treatment, its occurrence can also be controlled as much as possible through lifestyle adjustments. At the same time, various non-drug interventions, including massage, physical therapy, relaxation training, biofeedback, music therapy, etc., can relieve headache symptoms to a certain extent.