Indications for preventive treatment of migraine include frequent or severe attacks, contraindications to or toxicity with acute treatments, and patient preference. Drugs for acute treatment of migraine were reviewed in a previous issue.

An oral nonopioid analgesic is often sufficient for acute treatment of mild to moderate migraine pain without severe nausea or vomiting. A triptan is the drug of choice for treatment of moderate to severe migraine in most patients without vascular disease. Treatment of pain when it is still mild to moderate in intensity improves headache response and reduces the risk of recurrence.