New strategies for the treatment of migraine attacks

There is no consensus on which treatment strategy should be used in the acute therapy of migraine. A stratified care approach based on patient’s disabilty assessed by a valid instrument (the MIDAS questionnaire) has been proposed. An international controlled study, the DISC trial, showed that stratified care provided better clinical outcomes than step care across attacks or within attacks. An Italian study invited migraine patients with moderate– severe disability to treat 9 attacks according to one of two strategies: stratified care (i.e. triptans from the outset) or step care across attacks (i.e. with drug escalation from non–specific drugs to triptans, if the response was not satisfactory). This study should provide data useful for assessing the optimal treatment strategy in migraine.