Migraine

Abstract

Migraine is one of the most common pain disorders in the United States, affecting over 15% of the general population. Treatment guidelines exist regarding the use of both prophylactic and abortive therapies. However, there is still controversy over the utility and practice of polytherapy in those who do not respond to a first-line preventative agent. There is a small body of evidence to support the use of polytherapy for the management of refractory migraine, and a much larger pool of anecdotal clinical experience. In addition to the confusion between mono- and polytherapy, many new treatment modalities including injectable medications and nerve stimulators for episodic migraine have become available. The incorporation of these interventions into the migraine treatment plan will be discussed.