[Prophylactic medicines for migraine].

Migraine patients with frequent and disabling attacks should be given the opportunity to test prophylactic medicines, and general practitioners should know the indications and the main principles of treatment. When testing a preventative drug, it is important that the patient has realistic expectations, keeps a headache diary, increases the doses gradually, and takes an adequate dose for at least two months before the effect is assessed. Drugs licensed in Norway with adequate scientific documentation for use as migraine prophylactics include some antihypertensives (beta-blockers, candesartan and lisinopril), antiepileptics (topiramate, valproate and gabapentin), an antidepressant (amitriptyline), and botulinum toxin for chronic migraine. In the choice of medicine, one should consider scientific evidence, side effects and contraindications, effect on comorbid conditions, simplicity of use, and price. Patients who are severely affected should try at least three different drugs in succession.