The effectiveness and usefulness of prophylactic medications are evaluated by the degrees of reduction in frequency, severity and duration of headache, and by the degrees of improvement in functioning and disability in daily living. For some prophylactic therapies, scientific evidence has been obtained from randomized controlled trials (RCT). Some prophylactic therapies have been used empirically from the past. Since overuse of acute treatment drugs would induce medication-overuse headache, prophylactic therapy is also required in the case of excess use of acute medications. The goals of prophylactic therapy are to (1) reduce headache frequency, severity, and duration, (2) improve the response to treatment of acute attacks, and (3) improve function and reduce disability.
Prophylactic therapy is needed if disability in daily living due to migraine is not adequately relieved by acute treatment alone. Prophylactic therapy is recommended when migraine-induced disability in daily living remains with acute treatment alone, when acute treatment drugs cannot be used, and for special types of migraine with a risk of causing permanent neurological defects. CQ II-3-1 What kinds of patients requires prophylactic therapy? Recommendationįor patients who have migraine attacks two times or more or 6 days or more a month, consideration of prophylactic therapy is recommended.
