Pharmacological prevention of migraine.

People who have migraine experience intermittent attacks of unilateral, pulsating, and moderate to severe headache with associated nausea or photophobia and phonophobia (or all these symptoms). These attacks typically start before the age of 40, often in childhood or teenage years, and occur most commonly from the second to the fourth decade of life. Attacks may be infrequent or frequent. Chronic migraine is diagnosed when attacks regularly occur on more than 15 days a month. Box 1 shows the International Headache Soci‐ ety’s classification criteria for migraine without aura. Recent population studies have shown the worldwide prevalence of migraine to be greater than 10%. The preva‐ lence of migraine in the United States has been estimated at 18% for women, 6% for men, and 12% overall. 3 Migraine clearly affects women more than men, and its aetiology also seems to have a hereditary component. The World Health Organization ranks migraine 19th on the list of diseases worldwide that cause disability. In spite of recent advances in treatment options for migraine, both acute and preven‐ tive, these treatments continue to be underused, 4 which leaves patients with unnecessary suffering and increases the burden on the healthcare system. We review the different types of preventive treatment and discuss how they should be used to treat migraine effectively.