Update on Migraine Management

Lisa Larkin, MD, FACP, NCMP, IF


Menopause. 2022;29(5):606-608. 

In This Article


Early diagnosis of migraine is critical to reduce disability. Patients with migraine should be counseled to avoid migraine triggers, manage stress, practice good sleep hygiene, and exercise. Migraine-specific triptans should be first-line treatment unless contraindicated (pregnancy or cardiovascular disease), and patients should be educated on the benefit of early administration. If one triptan is not tolerated or is ineffective, a second triptan should be tried. If triptan use is limited by AEs or is contraindicated, rimegepant, urogepant, or lasmitidan may be considered. Migraine prevention should be considered for patients with PMM and EM with MRM and for those with two debilitating migraine headache days per month or more than four per month.[7] Standard preventive therapies are first line, and one of the injectable CGRP-targeted mAbs or oral gepants can be considered if standard options are ineffective or not tolerated.