Consider the following when prescribing prophylactic medication:
Educate patients on the need to take the medication daily and according to the prescribed frequency and dosage Ensure that patients have realistic expectations as to what the likely benefits of pharmacologic prophylaxis will be:
-Headache attacks will likely not be abolished completely -A reduction in headache frequency of 50% is usually considered worthwhile and successful -It might take 4–8 wk for substantial benefit to occur -If the prophylactic drug provides substantial benefit in the first 2 mo of therapy, this benefit might increase further over several additional months of therapy
Evaluate the effectiveness of therapy using patient diaries that record headache frequency, drug use, and disability levels For most prophylactic drugs, initiate therapy with a low dose and increase the dosage gradually to minimize side effects Increase the dose until the drug proves effective, until doselimiting side effects occur, or until a target dose is reached Provide an adequate drug trial. Unless side effects mandate discontinuation, continue the prophylactic drug for at least 6–8 wk after dose titration is completed Because migraine attack tendency fluctuates over time, consider gradual discontinuation of the drug for many patients after 6 to 12 mo of successful prophylactic therapy, but preventive medications can be continued for much longer in patients who have experienced substantial migraine-related disability
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