Headache Medicine 2021, 12(3):255-262 p-ISSN 2178-7468, e-ISSN 2763-6178

255

ASAA

DOI: 10.48208/HeadacheMed.2021.37

Headache Medicine

Original

Migraine cure: a patients' perspective

Mario Fernando Prieto Peres

1,2,3

, Alexandre Seram

, Arão Belitardo de Oliveira

3,4

Juliane Prieto Peres Mercante

3,4

¹Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

²Hospital Israelita Albert Einstein, São Paulo, Brazil

³Associação Brasileira de Cefaleia em Salvas e Enxaqueca, Sao Paulo, Brazil

Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, Brazil

Abstract

Objective

To conduct a web-based survey concerning patient’s perspective in the migraine cure.

Material and Methods

A total of 1,102 patients tting the International Classication of Headache Disorders (ICHD-

3) migraine criteria, seeking medical care at the Brain Research Institute at Albert Einstein

Hospital in Sao Paulo, Brazil, from January to December 2015, participated in the survey. The

online-based survey was accessed via the institute’s website and consisted of demographic

data, a description of migraine symptoms, diagnosis and treatment, and the patient’s opinion

of migraine cure and which treatment they would consider taking.

Results

Migraine intensity was signicantly higher in female participants than male participants.

Chronic migraine tended to affect female participants more than male participants. There

was a signicant difference in the rate of migraine cure belief between patients with episodic

and chronic migraine.

Conclusion

Some points that were important to migraineurs have been identied in this study. Ultimately,

the ndings of this study may facilitate the migraine treatment decision process, by providing

a better understanding of patients’ perspectives and beliefs, thus creating a more friendly

communication between migraineurs and care providers and hopefully, improving the quality

of life of patients.

Mario F. P. Peres, MD, PhD

E-mail: mario.peres@hc.fm.usp.br

Instituto de Psiquiatria, Hospital

das Clinicas HCFMUSP, Faculda-

de de Medicina, Universidade

de Sao Paulo, Sao Paulo, Brazil

Edited by:

Marcelo Moraes Valença

Keywords:

Belief

Cure

Headache

Migraine disorders

Survey

Quality of Life

Received: December 12, 2021

Accepted: December 28, 2021

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Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

Introduction

igraine is a common primary, but not exclusively, head-

ache disorder characterised by recurrent episodes of

headache, often associated with nausea, vomiting, photo-

phobia, and phonophobia. Although headache is the pri-

mary requirement for the diagnosis in many classications,

the manifestations of migraine may not include headache.

Global migraine prevalence is reported to be around 11.5%

with variation between countries, sexes and socio-economic

status.

A recently published report provided updates on the

prevalence of migraine and severe headache in the United

States. It has been reported that prevalence estimates have

remained remarkably stable for many years, but migraine

continues to be a common, disabling medical condition

that affects almost one in six Americans.

Alone, migraine

is the sixth leading cause of disability of any condition,

and is the leading cause of neurological disability globally.

In Brazil, the 1-year prevalence of migraine is 15.2% and

migraine is a leading cause of disability in terms of days

lost from work, school or domestic activities.

The management of migraine includes both acute

medications and prophylactic treatment.

Because

migraine can be observed as a progressive or pervasive

disorder, the prophylactic treatment may slow or

prevent such progression

6,7

. Prophylactic treatments may

include medications such as topiramate

, gabapentin

tizanidine

, uoxetine

, amitriptyline

, and valproate

local injections of botulinum neurotoxin

For acute treatment, options included analgesics such as

acetylsalicylic acid and acetaminophen (paracetamol), the

combination of analgesics with caffeine, non-steroidal anti-

inammatory drugs (NSAIDs) such as ibuprofen, naproxen,

ketoprofen or diclofenac

14,15

, and other medications with

less clear mechanisms of action, such as metamizole

Ergotamine preparations have also been used.

Depending on the measure used, many patients are non-

responsive to the aforementioned treatments; therefore, new

drugs

have been proposed. Successful new approaches

for the treatment of acute migraine target calcitonin gene-

related peptide (CGRP) and serotonin (5-hydroxytryptamine,

5-HT1F) receptors. In migraine prevention, the most

promising new approaches are humanised antibodies

against CGRP or the CGRP receptor.

Alternative

approaches

19,20

include food or dietary supplements

that provide medicinal or health benets (i.e. riboavin,

coenzyme Q10, magnesium, butterbur root extract, and

feverfew)

, behavioral interventions (i.e. relaxation, thermal,

electromyographic biofeedback, stress management and

cognitive-behavioural therapy) which have been used

in migraine therapy to help patients to better cope with

symptoms and identify potential triggers for headache

22,23

invasive or non-invasive neuromodulation

, acupuncture

, meditation

25,26

, and others. Although the efcacy of

behavioral interventions for migraine is well established,

other emerging behavioral therapies show considerable

promise for improving outcomes of migraine patients,

particularly in reducing headache-related disability

and affective distress, but efcacy to date is limited.

Despite the numerous treatments available, many people

suffer prolonged and frequent attacks which have a major

impact on their quality of life. The majority of studies

focused solely on efcacy, tolerability or discontinuation

rates of treatments; however, some migraineurs may never

achieve the goal of becoming permanently pain free

and treatments may prioritise the outcome of improved

functioning above symptom reduction.

Nevertheless, the patient's perception of an improvement

of symptoms and a cure of migraine is still unknown.

Therefore, we conducted a qualitative study to understand

the patient’s perspective concerning migraine cure and

which treatment outcomes are most important for those

patients.

Material and Methods

Experimental Design

This study enrolled 1,102 patients tting the International

Classication of Headache Disorders (ICHD-3) migraine

criteria

seeking medical care, from January to December

2015, at the Brain Research Institute at Albert Einstein

Hospital, located in Sao Paulo, Brazil.

All patients answered questions concerning their medical

care, preference for treatment, and opinions on migraine

cure via a web-based survey.

Written informed consent was obtained, in which patients

agreed to share their responses for research purposes, and

the study was approved by the local institutional review

board.

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Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

Questionnaire

The online-based survey was accessed via the institute’s

website and consisted of three main sessions. The rst

session contained questions concerning demographic

data such as age and sex and description of migraine

symptoms; the second session included migraine diagnosis

and treatment; and the third session investigated the

patient’s opinion about migraine cure and which treatment

they would consider taking (Table1).

Statistical analysis

Data are expressed as the mean ± standard deviation

for continuous variables, while percentages are used for

categorical variables. Generalised linear models (GzLM)

were used to investigate the following relationships:

- Participants’ sex and migraine intensity (from one to ten),

using gamma with log link distribution;

- Chronic migraine and migraine cure belief, using binary

logistic regression;

- Participants’ sex and age and (i) chronic migraine, and

(ii) migraine cure belief, using binary logistic regression.

The results are expressed as unstandardised regression

coefcient (B), or odds ratio (OR), with 95% condence

intervals (CI) and p-values. The α error rate adopted was

5%. The analysis was performed using SPSS Statistics 21

(IBM, New York, New York, USA).

Table 1. Description of the online-based survey

Questions Possible answers

How long have you been experiencing headaches for?

Fill in the blank

How many days per month do you experience headaches?

Fill in the blank

On how many of these days do you have a headache that is disabling (made you stop doing something or made it difcult for you to do something)?

Fill in the blank

From one to ten, what is the intensity of the headache (one is the weakest possible and ten is the strongest possible)?

Fill in the blank

Which of the following descriptions best describe your headache crises?

Pulsating, throbbing pain

Weight or tightening on the head

Twinge of pain

Burning

Where in the head do you feel the pain?

Switches from one or the other side of the head

On one side of the head

On both sides of the head

What other symptoms do you experience?

Nausea or vomiting

Anxiety or tension

Unpleasant with noise

Smothered by smells

Discomfort with light

Worsening pain with movements

Irritability

Do dark spots, light spots, or zigzag lines appear in your vision before or during the headache?

Yes

Not

For how long do dark spots, light spots, or zigzag lines appear in your vision before or during the headache?

A few seconds

Less than ve minutes

Five to sixty minutes

More than sixty minutes

Would you take any measures to prevent headaches, such as daily medicine intake?

Yes

Not

Have you looked for a physician to treat your headaches?

Never

Yes, a gynaecologist

Yes, a general practitioner

Yes, a psychiatrist

Yes, a neurologist

Yes, others

Have you had any tests to detect the causes of your headaches?

No never

Yes, general blood tests

Yes, computed tomography

Yes, electroencephalogram

Yes, magnetic resonance imaging

Do you believe that there is a cure for migraines?

Yes

Not

Which of the following do you consider to be indicative of a migraine cure?

50% improvement in migraine attacks

90% improvement in migraine attacks

Never again experiencing a headache

Never again experiencing a strong headache

For a month to pass without a headache

For a month to pass with controlled, weak headaches

For three months to pass without a headache

For three months to pass with controlled, weak headaches

For one year to pass without a headache

For one year to pass with controlled, weak headaches

For three years to pass without a headache

For three years to pass with controlled, weak headaches

To stop a migraine attack faster

Considering that the following treatments are effective, which ones would you take?

Daily prescription medicines for three months

Daily prescription medicines for one year

Botox injections every six to twelve months

Acupuncture once a week for three months

Psychotherapy once a week for three months

Physiotherapy once a week for three months

Religious, spiritual treatment, once a week for three months

Daily herbal medicine for three months

Daily herbal medicine for one year

Exercising three times a week for three months

Exercising three times a week for a year

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Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

Results

A total of 1,102 subjects participated in the survey, of

which 935 were women (84.9%) and 166 (15.1%) were

men. The mean participant age was 33.3 years ± 10.4

(range: 7–77). The mean period experiencing migraine

was 14.4 years ± 10.3 (range: 1–63). The mean number

Table 1. Description of the online-based survey

Questions and answers n (%)

From one to ten, what is the intensity of the headache (one is the weakest possible and

ten is the strongest possible)?

1 4 (0.4)

2 4 (0.4)

3 8 (0.7)

4 14 (1.3)

5 49 (4.4)

6 60 (5.4)

7 146 (13.2)

8 313 (28.4)

9 196 (17.8)

10 308 (27.9)

Which of the following descriptions best describe your headache crises?

Pulsating, throbbing pain 904 (82.0)

Weight or tightening on the head 461 (41.8)

Twinge of pain 341 (30.9)

Burning 152 (13.8)

Where in the head do you feel the pain?

Switches from one or the other side of the head 525 (47.6)

On one side of the head 345 (31.3)

On both sides of the head 232 (21.1)

What other symptoms do you experience?

Nausea 859 (78.0)

Vomiting 384 (34.8)

Anxiety or tension 520 (47.2)

Unpleasant with noise 834 (75.7)

Smothered by smells 650 (59.0)

Uncomfortable with light 873 (79.2)

Worsening pain with movements 778 (70.6)

Irritability 762 (69.1)

Do dark spots, light spots, or zigzag lines appear in your vision before or during the

headache?

Yes 594 (53.9)

Not 508 (46.1)

For how long do dark spots, light spots, or zigzag lines appear in your vision before

or during the headache?

A few seconds 214 (19.4)

Less than ve minutes 156 (14.2)

Five to sixty minutes 180 (16.3)

More than sixty minutes 70 (6.4)

Have you searched for a physician to treat your headaches?

Not 109 (9.9)

of days per month experiencing migraine was 13.6 days ±

8.8 (range: 1–30). The mean number of days experiencing

disabling migraine was 6.5 days ± 5.8 (range: 1–30).

Chronic migraine (frequency ≥ 15 days per month) was

observed in 498 (45.2%), and episodic migraine in 604

participants (54.8%).

Yes, a gynaecologist 163 (14.8)

Yes, a general practitioner 290 (26.3)

Yes, a psychiatrist 111 (10.1)

Yes, a neurologist 803 (72.9)

Yes, others 155 (14.1)

Have you had any tests to detect the causes of your headaches?

No, never 289 (26.2)

Yes, general blood tests 361 (32.8)

Yes, computed tomography 525 (47.6)

Yes, electroencephalogram 426 (38.7)

Yes, magnetic resonance imaging 287 (26.0)

Do you believe there is a cure for migraine?

Yes 507 (46.0)

Not 595 (54.0)

Which of the following do you consider to indicate a migraine cure?

50% improvement in migraine attacks 63 (5.7)

90% improvement in migraine attacks 417 (37.8)

Never again experiencing a headache 308 (27.9)

Never again experiencing a strong headache 274 (24.9)

For a month to pass without a headache 117 (10.6)

For a month to pass with controlled, weak headaches 33 (3.0)

For three months to pass without a headache 57 (5.2)

For three months to pass with controlled, weak headaches 15 (1.4)

For one year to pass without a headache 77 (7.0)

For one year to pass with controlled, weak headaches 35 (3.2)

For three years to pass without a headache 59 (5.4)

For three years to pass with controlled, weak headaches 37 (3.4)

To stop a migraine attack faster 424 (38.5)

Daily prescription medicine for three months 559 (50.7)

Daily prescription medicine for one year 489 (44.4)

Botox injections every six to twelve months 286 (26.0)

Acupuncture once a week for three months 530 (48.1)

Psychotherapy once a week for three months 290 (26.3)

Physiotherapy once a week for three months 312 (28.3)

Religious, spiritual treatment, once a week for three months 221 (20.1)

Daily herbal medicine for three months 328 (29.8)

Daily herbal medicine for one year 340 (30.9)

Exercising three times a week for three months 312 (28.3)

Exercising three times a week for a year 511 (46.4)

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Migraine cure: a patients' perspective

Migraine intensity was signicantly higher in female

participants than in male participants (8.3 ± 0.1 vs. 7.8 ±

0.1, p = 0.002, respectively, B: 0.058, CI: 0.020–0.096).

Chronic migraine tended to affect female participants more

than male participants (46.2% vs. 39.2%, p = 0.088).

Chronic migraine was not signicantly associated with

participants’ age (OR: 1.000, CI: 0.989–1.012, p =

0.935).

A total of 45.2% of female participants and 50.0% of

male participants reported believing that there is a cure for

migraine (p = 0.258). There was a signicant difference

in the rate of migraine cure belief between patients with

acute and chronic migraine (49.0% vs. 42.4%, p = 0.027,

respectively; OR: 0.765, CI: 0.602–0.971). Believing in

a cure for migraine was neither signicantly associated

with participants’ sex (OR: 0.826, CI: 0.594–1.150, p =

0.257) nor with participants’ age (OR: 0.997, CI: 0.985–

1.008, p = 0.579).

Discussion

Despite the major advances in dening migraine

pathophysiology and the subsequent discovery of novel

medicines for the acute treatment and prevention of

migraine headaches, the process of conducting research

and analysing evidence reveals gaps in our understanding

of which and how treatments should be conducted and

for which kind of patient. There is also a general lack of

understanding concerning patient beliefs and treatment

decision processes related to the use of migraine

medications.

The present study investigated the patient’s perspective

of migraine cure and which treatment outcomes are most

important for migraine patients. When asked about the cure

for migraine, the majority of patients reported not believing

in the cure and less than one-third of participants consider

migraine cure as to "never experience a headache again"

or to “never experience a strong headache again”, while

most patients consider “stopping a migraine attack faster”

or a “90% improvement in migraine attacks” to indicate

a migraine cure. In addition, there was a signicant

difference in the rate of migraine cure belief between

patients with acute and chronic migraine, with the belief in

the cure of a migraine being decreased by more than 70%

among chronic migraineurs.

As reported by Smitherman et al.

, many chronic

pain patients will never achieve the often unrealistic

goal of becoming permanently pain free. Cognitive

distortions as catastrophizing can negatively impact

the patient´s perception of results, and adherence to

treatment. Therefore, the clinician-patient conversation

about preventive therapies must set realistic expectations

regarding the likely magnitude of benet, considering

that a reduction but not elimination of migraine burden

is expected. Providing a rationale education is critical for

engaging patients with migraine in treatment.

Patients with chronic migraine represent the more severe

end of the spectrum. To meet diagnostic criteria for chronic

migraine, patients must have a history of migraine, and

have had a headache for more than 14 days a month

for at least 3 months.

Our evidence suggests that this

group of patients have less hope of a cure. Future studies

could investigate the consequences of these belief, as non-

adherence to treatment.

It has been described that feelings of pain and aspects

of emotional, physical, and social functioning impacted

by pain may inuence treatment outcomes.

Also, the

pain behaviour is inuenced by private events, including

thoughts and beliefs and one’s response to those cognitive

processes.

In light of this, psychological approaches to

treat chronic pain may be valuable.

Alternative treatments including acceptance and

commitment therapy

, mindfulness-based interventions

27,

, and others have been investigated and proved to

be efcient for the treatment of migraine. When asked

which treatment to consider, most patients opted for

more conventional approaches, such as taking “daily

prescription medicines” or to “exercising three times a

week”; however, other less conventional strategies have

also been considered, such as acupuncture and, by fewer

participants, even religious and spiritual treatments.

The treatments suggested here and other aforementioned

alternatives are preventive approaches. However, “to have

the migraine attacks blocked faster” was considered to

indicate a cure for migraine by most of the participants. In a

previously reported analysis of the needs and expectations

of patients who present to the emergency department for

the management of migraine, it was also observed that

migraine patients express an appreciation for medications

that afforded the rapid and durable relief of headache;

however, complaints about medication-induced side

effects, particularly drowsiness and dizziness, are also

common.

There are many options for acute migraine attack treatment,

but none are ideal for all patients. It was recognised over

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Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

a century ago that patient response to medications for

migraine attacks is idiosyncratic and that treatment must be

tailored to the individual.

Medication choice for the acute

treatment of migraine attacks is difcult, given the multiple

medications available and the fact that one cannot predict

which medication will work best for any given patient.

Acute migraine treatment in chronic migraine is particularly

important. The acute medications used in these cases are

the same as those used in episodic migraine and acute

migraine; in chronic migraine, however, presents a difcult

challenge because of the high headache frequency and

the importance of avoiding medication overuse.

Corroborating previous reports, it was observed in

the present study that women are more likely to have

migraine than men. Burch et al.

reported that one in

ve women between the ages of 15 and 64 years old

have experienced migraine or severe headache in the

previous three months. The female preponderance of

migraine seems to be related to hormonal milestones

33,

. Considerable evidence has linked ovarian steroid

hormones oestrogen and progesterone to migraine.

35-37

Fluctuations in oestrogen levels inuence migraine attacks,

with oestrogen withdrawal before menses probably being

a notable trigger

. This highlights the importance of

expanding knowledge of reproductive endocrinology in

the management of migraine in the largest population of

migraineurs, in women.

This study has limitations. Given the self-reported nature

of this survey, the possibility of misreporting cannot be

excluded. In addition, the survey enrolled patients seeking

medical care at a Brain Research Institute, where severe

migraineurs are likely over-represented compared with the

general population. More than 45% of our population

were chronic migraineurs, which is not representative of

the general population. Nevertheless, data acquired from

this population could help to understand the perspective

concerning migraine treatment and cure of a large cross-

section of the most disabled migraineurs.

In conclusion, some points that were important to

migraineurs have been identied in this study. Despite the

majority of our patients showing disbelief in the existence

of a migraine cure, most of those that reported believing

in a cure considered “cure” a rapid relief of headache.

In addition, chronic migraineurs’ belief in the existence of

a migraine cure was dramatically affected. Ultimately, the

ndings of this study may facilitate the migraine treatment

decision process by providing a better understanding of

patients’ perspectives and beliefs, thus creating a more

friendly communication between migraineurs and care

providers and hopefully, improving patients’ quality of life.

References

1. Headache Classication Committee of the

International Headache S. The International

Classification of Headache Disorders, 3rd edition

(beta version).

Cephalalgia

2013;33(9):629-808

Doi:10.1177/0333102413485658

2. Woldeamanuel YW and Cowan RP. Migraine affects

1 in 10 people worldwide featuring recent rise: A

systematic review and meta-analysis of community-

based studies involving 6 million participants.

Neurol Sci

2017;372(307-315 Doi:10.1016/j.

jns.2016.11.071

3. Burch R, Rizzoli P and Loder E. The Prevalence and

Impact of Migraine and Severe Headache in the

United States: Figures and Trends From Government

Health Studies.

Headache

2018;58(4):496-505

Doi:10.1111/head.13281

4. Global Burden of Disease Study C. Global, regional,

and national incidence, prevalence, and years lived

with disability for 301 acute and chronic diseases and

injuries in 188 countries, 1990-2013: a systematic

analysis for the Global Burden of Disease Study 2013.

Lancet

2015;386(9995):743-800 Doi:10.1016/

S0140-6736(15)60692-4

5. Vo P, Wen S, Martel MJ, Mitsikostas D, Reuter U

and Klatt J. Benefit-risk assessment of erenumab

and current migraine prophylactic treatments

using the likelihood of being helped or harmed.

Cephalalgia

2018;333102418801579

Doi:10.1177/0333102418801579

6. Krymchantowski AV, Silva MT, Barbosa JS and Alves

LA. Amitriptyline versus amitriptyline combined

with fluoxetine in the preventative treatment of

transformed migraine: a double-blind study.

Headache

2002;42(6):510-514, https://www.ncbi.

nlm.nih.gov/pubmed/12167139

7. Bigal ME, Rapoport AM and Hargreaves R.

Advances in the pharmacologic treatment of

tension-type headache.

Curr Pain Headache Rep

2008;12(6):442-446, https://www.ncbi.nlm.nih.

gov/pubmed/18973738

8. Silberstein SD, Feliu AL, Rupnow MF, Blount AC and

Boccuzzi SJ. Topiramate in migraine prophylaxis:

long-term impact on resource utilization and cost.

Headache

2007;47(4):500-510 Doi:10.1111/

j.1526-4610.2007.00754.x

9. Spira PJ, Beran RG and Australian Gabapentin

261

ASAA

Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

Chronic Daily Headache G. Gabapentin in

the prophylaxis of chronic daily headache: a

randomized, placebo-controlled study.

Neurology

2003;61(12):1753-1759, https://www.ncbi.nlm.nih.

gov/pubmed/14694042

10. Saper JR, Lake AE, 3rd, Cantrell DT, Winner PK

and White JR. Chronic daily headache prophylaxis

with tizanidine: a double-blind, placebo-

controlled, multicenter outcome study.

Headache

2002;42(6):470-482, https://www.ncbi.nlm.nih.

gov/pubmed/12167135

11. Saper JR, Silberstein SD, Lake AE, 3rd and Winters ME.

Double-blind trial of fluoxetine: chronic daily headache

and migraine.

Headache

1994;34(9):497-502,

https://www.ncbi.nlm.nih.gov/pubmed/8002320

12. Sarchielli P, Messina P, Cupini LM, Tedeschi G, Di

Piero V, Livrea P, . . . Calabresi P. Sodium valproate

in migraine without aura and medication overuse

headache: a randomized controlled trial.

Eur

Neuropsychopharmacol

2014;24(8):1289-1297

Doi:10.1016/j.euroneuro.2014.03.010

13. Herd CP, Tomlinson CL, Rick C, Scotton WJ,

Edwards J, Ives N, . . . Sinclair A. Botulinum

toxins for the prevention of migraine in adults.

Cochrane Database Syst Rev

2018;6(Cd011616

Doi:10.1002/14651858.CD011616.pub2

14. Holland S, Silberstein SD, Freitag F, Dodick DW,

Argoff C, Ashman E, . . . the American Headache

S. Evidence-based guideline update: NSAIDs

and other complementary treatments for episodic

migraine prevention in adults: report of the Quality

Standards Subcommittee of the American Academy

of Neurology and the American Headache Society.

Neurology

2012;78(17):1346-1353 Doi:10.1212/

WNL.0b013e3182535d0c

15. Silberstein SD, Holland S, Freitag F, Dodick DW,

Argoff C, Ashman E, . . . the American Headache

S. Evidence-based guideline update: pharmacologic

treatment for episodic migraine prevention in adults:

report of the Quality Standards Subcommittee of the

American Academy of Neurology and the American

Headache Society.

Neurology

2012;78(17):1337-

1345 Doi:10.1212/WNL.0b013e3182535d20

16. Ramacciotti AS, Soares BG and Atallah AN. Dipyrone

for acute primary headaches.

Cochrane Database Syst

Rev

2007;2):CD004842 Doi:10.1002/14651858.

CD004842.pub2

17. Dahlof C and Maassen Van Den Brink A.

Dihydroergotamine, ergotamine, methysergide

and sumatriptan - basic science in relation to

migraine treatment.

Headache

2012;52(4):707-714

Doi:10.1111/j.1526-4610.2012.02124.x

18. Diener HC, Charles A, Goadsby PJ and Holle D.

New therapeutic approaches for the prevention

and treatment of migraine.

Lancet Neurol

2015;14(10):1010-1022 Doi:10.1016/S1474-

4422(15)00198-2

19. Smitherman TA, Wells RE and Ford SG. Emerging

behavioral treatments for migraine.

Curr Pain

Headache Rep

2015;19(4):13 Doi:10.1007/

s11916-015-0486-z

20. Puledda F and Shields K. Non-Pharmacological

Approaches for Migraine.

Neurotherapeutics

2018;15(2):336-345 Doi:10.1007/s13311-018-

0623-6

21. Wells RE, Bertisch SM, Buettner C, Phillips RS and

McCarthy EP. Complementary and alternative

medicine use among adults with migraines/severe

headaches.

Headache

2011;51(7):1087-1097

Doi:10.1111/j.1526-4610.2011.01917.x

22. Penzien DB, Irby MB, Smitherman TA, Rains JC

and Houle TT. Well-Established and Empirically

Supported Behavioral Treatments for Migraine.

Curr

Pain Headache Rep

2015;19(7):34 Doi:10.1007/

s11916-015-0500-5

23. Powers SW, Kashikar-Zuck SM, Allen JR, LeCates

SL, Slater SK, Zafar M, . . . Hershey AD. Cognitive

behavioral therapy plus amitriptyline for chronic

migraine in children and adolescents: a randomized

clinical trial.

JAMA

2013;310(24):2622-2630

Doi:10.1001/jama.2013.282533

24. Linde K, Allais G, Brinkhaus B, Fei Y, Mehring

M, Vertosick EA, . . . White AR. Acupuncture for

the prevention of episodic migraine.

Cochrane

Database Syst Rev

2016;6):Cd001218

Doi:10.1002/14651858.CD001218.pub3

25. Wachholtz AB, Malone CD and Pargament KI. Effect

of Different Meditation Types on Migraine Headache

Medication Use.

Behav Med

2017;43(1):1-8 Doi:10

.1080/08964289.2015.1024601

26. Keller A, Meyer B, Wohlbier HG, Overath CH and

Kropp P. Migraine and Meditation: Characteristics

of Cortical Activity and Stress Coping in Migraine

Patients, Meditators and Healthy Controls-An

Exploratory Cross-Sectional Study.

Appl Psychophysiol

Biofeedback

2016;41(3):307-313 Doi:10.1007/

s10484-016-9334-0

27. Schwedt TJ. Preventive Therapy of Migraine.

Continuum

(Minneap Minn)

2018;24(4, Headache):1052-1065

Doi:10.1212/con.0000000000000635

28. McCracken LM and Vowles KE. Acceptance and

commitment therapy and mindfulness for chronic

pain: model, process, and progress.

Am Psychol

2014;69(2):178-187 Doi:10.1037/a0035623

262

ASAA

Peres MFP, Serafim A, Oliveira AB, Mercante JPP

Migraine cure: a patients' perspective

29. Andrasik F, Grazzi L, D'Amico D, Sansone E, Leonardi

M, Raggi A and Salgado-Garcia F. Mindfulness

and headache: A "new" old treatment, with new

findings.

Cephalalgia

2016;36(12):1192-1205

Doi:10.1177/0333102416667023

30. Friedman BW, Lian J, Irizarry E, Mayat S, Rosa K,

Bijur PE and Gallagher EJ. A qualitative analysis of

the needs and expectations of patients who present

to the emergency department for management of

migraine.

Am J Emerg Med

2018;36(7):1314-1315

Doi:10.1016/j.ajem.2017.11.039

31. Becker WJ. Acute Migraine Treatment in Adults.

Headache

2015;55(6):778-793 Doi:10.1111/

head.12550

32. Marmura MJ, Silberstein SD and Schwedt TJ. The

acute treatment of migraine in adults: the american

headache society evidence assessment of migraine

pharmacotherapies.

Headache

2015;55(1):3-20

Doi:10.1111/head.12499

33. Brandes JL. Migraine in women.

Continuum (Minneap

Minn)

2012;18(4):835-852 Doi:10.1212/01.

con.0000418646.70149.71

34. Nappi RE and Nappi G. Neuroendocrine aspects of

migraine in women.

Gynecol Endocrinol

2012;28

Suppl 1(37-41 Doi:10.3109/09513590.2012.6519

35. Sumelahti ML. [Woman, hormones and migraine].

Duodecim

2013;129(4):345-350,

36. Silberstein SD and Hutchinson SL. Diagnosis and

treatment of the menstrual migraine patient.

Headache

2008;48 Suppl 3(S115-123 Doi:10.1111/j.1526-

4610.2008.01309.x

37. Rothrock JF. Menstrual migraine.

Headache

2009;49(9):1399-1400 Doi:10.1111/j.1526-

4610.2009.01527.x

38. Pakalnis A. Migraine and Hormones.

Semin

Pediatr Neurol

2016;23(1):92-94 Doi:10.1016/j.

spen.2016.01.005