Clinical advances in the preventive treatment of migraine.

Evidence is emerging on the physiological processes underlying episodic migraine and the rationale for preventive treatment. Objectives for preventive treatment include limiting future pain and disability and potentially modulating the course of disease progression. Many factors influence medication choice for patients such as migraine type, patient preference, co-existing conditions, and medication side effects. In this paper, frequently prescribed treatment options for migraine prevention are reviewed. Most headache preventive medications treat other medical disorders and are found serendipitously to be beneficial in migraine or other headache disorders. A new treatment option is topiramate, with proven safety and efficacy across the largest controlled migraine prevention trials conducted to date. New clinical information is enhancing patient care and enabling clinicians to ease the burden of migraine worldwide.