This protocol addresses migraine without aura when the attack burden crosses a clear threshold: three or more migraine attacks per month with a measurable negative impact on quality of life, or individual attacks that regularly last longer than 72 hours. In either situation, acute treatment alone is insufficient and a preventive strategy becomes necessary.
The protocol specifies drug prophylaxis using a single agent with high documented evidence of efficacy. Treatment is introduced with a start low, go slow titration strategy — the complete selection of recommended agents, criteria for choosing among them, and dosing guidance are set out in the full regimen.
Prevention is considered effective when it achieves a reduction in attack frequency of 50% or more, evaluated 2 months after reaching the highest tolerated dose.
DOI: 10.1177/2514183X1882337
Three or more migraine attacks per month with negative impact on quality of life;
Migraine attacks which regularly last longer than 72 h;
The preventive effect of the beta blockers propranolol and metoprolol, the calcium antagonist flunarizin and the anti-convulsants valproic acid and topiramate and amitriptyline are best-documented in controlled studies (Table 4).
Medications for migraine prevention should be given in slowly increasing doses.
Due to its teratogenic properties, valproic acid should not be prescribed for women of childbearing potential or only after instruction concerning reliable contraception.
Migraine prevention is considered effective when it achieves a reduction of the migraine attack frequency of 50% or more.
The effectiveness, defined as a reduction of migraine days by ≥50%, can be evaluated 2 months after reaching the highest tolerated dose.
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