Prophylactic medication is indicated in the following circumstances: Recurrent migraine attacks are causing considerable disability despite optimal acute drug therapy Frequency of acute medication use is approaching levels that place the patient at risk of medication-overuse headache -acute medications are used on ≥ 10 d/mo for triptans, ergots, opioids, and combination analgesics -acute medications are used on ≥ 15 d/mo for acetaminophen and NSAIDs Recurrent attacks with prolonged aura are occurring (hemiplegic migraine, basilar-type migraine, etc) Contraindications to acute migraine medications are making symptomatic treatment of migraine attacks difficult

NSAID—nonsteroidal anti-inflammatory drug.

Based on expert opinion of the Guideline Development Group.