Strategies of care for acute treatment of migraine

The clinical questions posed by the advent of acute migraine-specific treatment (triptans) are on which patient to use specific treatment for migraine, and when in the attack to treat patients. Three strategies have been proposed for selecting treatment for acute migraine, and these strategies were studied in The Disability in Strategies of Care (DISC) study: step care across attacks, step care within attacks, and stratified care. Stratified care, which matches treatment to level of disability is superior to the other two strategies. A recent prospective study suggests that triptans should be used during the mild phase of pain for optimal benefit. Thus, patients with time loss from episodic migraine are optimal candidates for triptan therapy from the beginning, and treating early in attacks, without delay, optimizes the likelihood of pain relief and reducing that time loss and disability.