Points to consider before starting prophylactic treatment

The practitioner treating migraine should remember:

• contraceptive measures should be reassessed if a female patient is of child-bearing age
  
  
• other medication that may trigger headaches, especially vasodilators, should be discontinued
  
  
• if patients take large amounts of medication to treat headaches then they may not respond to preventative medication because the drugs compete for monoamine- receptor sites; in this instance the former medication should be discontinued
  
  
• drugs should be taken for 2-3 months to permit true appraisal of effects
  
  
• start at a low dose - increments should be such that no more than 3 steps are needed to achieve maximal dose
  
  
• duration of treatment - this is generally 6 months or longer - then the drug is gradually withdrawn after the frequency of headaches diminishes