Migraine can have a number of presentations, classical migraine being the most common, manifesting as one-sided pulsating headache usually associated with nausea/vomiting, oversensitization to lights and loud noise (photophobia and phonophobia, respectively). But migraine may have alternate presentations. Also, other possible and common cause for headache, such as tension headache, should be ruled out. As such, in order to make the proper diagnosis and prescribe the correct treatment, a full and detailed assessment of the attacks of headache is required.
If indeed it turns out to be migraine, there is a number of potential therapies, which are categorized into:
1- Maintenance treatment: the aim of maintenance therapy is to prevent migraine attacks. We usually start with simple non steroidal anti-inflammatory drugs NSAIDs) and check for response. If no improvement is achieved, we move to other classes of medications, such as calcium-channel blockers, and maybe triptans.
2- Abortive treatment: such treatment is used when the migraine attack happens and serves to sever the attack. In this kind of therapy we resort to potent pain killers usually given as a muscular injection.
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