Patients may be candidates for preventive therapy if any of the following criteria apply:
An adequate treatment duration of any prophylactic substance is important because clinical benefits may not become apparent for 2 to 3 months. As such, butterbur should be used at least for several months. After a period "free of migraine" consideration can be given to tapering or discontinuing the substance.
Adapted from the American Academy of Family Physicians and the American College of Physicians - American Society of Internal Medicine guidelines for the management of migraines.
*Even patients with <2 attacks per month may experience disability severe enough to require preventative treatment.3
1. Snow V. Weiss, K. Wall, EM, Mottur-Pilson C., for the American Academy of Family Physicians and the American College of Physicians-American Society of Internal Medicine. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002;137:840-849. 2. Ramadan NM, Silberstein SD, Freitag FG, Gilbert TT, Frishberg BM, and the US Headache Consortium. Evidence based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine. American Academy of Neurology. US Headache Consortium. 2000: 1-55. 3. Tfelt-Hansen P. Prophylactic pharmacotherapy of migraine: some practical guidelines. Neurol Clin. 1997;15:153165.