Long-Term Prophylaxis of Migraine

Only few studies evaluated the long-term effectiveness of the prophylactic therapy of migraine. In this study we evaluate the optimal length of the prophylaxis in migtaineurs. The length of the prophylactic therapy was evaluated in 68 outpatients with migraine without aura. The drugs dosage was adjusted upon clinical response while maintaining the aim of reducing the headaches frequency by at least 75%. Following a minimum of three months of well-being, a gradual tapering of the tested drug was attempted; whenever this resulted in worsening conditions, the original dosage was restored. The follow-up lasted from a minimum of one year to a maximum of five years. The prophylaxis mean length was 15.4 ± 15.3 months, ranging from two to 60 months; 33 (48.5%) patients with migraine required longer than one year of prophylaxis. In 14 (36.8%) patients with migraine who worsened after withdrawal of the prophylaxis, the drug previously effective became ineffective when prescribed again. According to the recent studies, a significant number of patients require longer prophylaxis than usually advised by the guidelines. Besides, in a significant number of patients, one drug previously effective became ineffective if prescribed again after suspension.