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Points to consider before starting prophylactic treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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  • duration of treatment - this is generally 6 months or longer - then the drug is gradually withdrawn after the frequency of headaches diminishes

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