The following may be considered indications for prophylactic migraine therapy:
- Migraine variants, such as hemiplegic migraine or rare headache attacks producing profound disruption or risk for permanent neurologic injury
- Frequency of migraine attacks is greater than 2 per month
- Duration of individual attacks is longer than 24 hours
The headaches cause major disruptions in the patient’s lifestyle, with significant disability that lasts 3 or more days- Abortive therapy fails or is overused
- Symptomatic medications are contraindicated or ineffective
- Use of abortive medications more than twice a week
