[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-142840-en":3,"doc-seo-142840-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},142840,34359740700684,"Finn","https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487",7,"Healthcare","Optimizing prophylactic treatment of migraine: Subtypes and patient matching","Advances in migraine pathophysiology have enabled targeted therapies, including triptans for acute relief via serotonin-related cerebrovascular mechanisms and renewed preventive interest in antiepileptic drugs prompted by cortical spreading depression. Despite progress, migraine remains inadequately treated because it presents as a syndrome rather than a single disease. Preventive care may need patient-specific matching, structured by adrenergic, serotoninergic, menstrual, and muscular precipitating patterns, and guided by the potential impact of appropriate early prophylaxis on long-term outcomes and late complications.","Therapeutics and Clinical Risk Management downloaded from [https://www.dovepress.com/](https://www.dovepress.com/)  \nFor personal use only.  \nREVIEW  \nOptimizing prophylactic treatment of migraine: Subtypes and patient matching  \nMichel Dib  \nFédération du système nerveux central, Hôpital de la Salpêtrière, Assistance Publique- Hôpitaux de Paris, France  \nCorrespondence: Dr Michel Dib Fédération du système nerveux central, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris, France Tel +33 1 45 70 91 90  \nFax +33 1 45 70 91 50  \nEmail [dib.michel@wanadoo.fr](dib.michel@wanadoo.fr)  \nAbstract: Advances in our understanding of the pathophysiology of migraine have resulted in important breakthroughs in treatment. For example, understanding of the role of serotonin in the cerebrovascular circulation has led to the development of triptans for the acute relief of migraine headaches, and the identification of cortical spreading depression as an early central event associated wih migraine has brought renewed interest in antiepileptic drugs for migraine prophylaxis. However, migraine still remains inadequately treated. Indeed, it is apparent that migraine is not a single disease but rather a syndrome that can manifest itself in a variety of pathological conditions. The consequences of this may be that treatment needs to be matched to particular patients. Clinical research needs to be devoted to identifying which sort of patients benefit best from which treatments, particularly in the field of prophylaxis. We propose four patterns of precipitating factors (adrenergic, serotoninergic, menstrual, and muscular) which maybe used to structure migraine prophylaxis. Finally, little is known about long-term outcome in treated migraine. It is possible that appropriate early prophylaxis may modify the long-term course of the disease and avoid late complications.  \nKeywords: migraine, diagnosis, treatment, prophylaxis, subtypes  \nMigraine headaches are the most frequent type of incapacitating headache and one of the most common reasons for consultation in neurology. However, these headaches have historically been poorly understood in terms of natural history, pathophysiology and prognosis. This unsatisfactory state of affairs had important consequences for the diagnosis and treatment of migraine, which have been frequently inadequate. Indeed, the first rational classification of headache semiology, providing an unambiguous definition of migraine was established relatively recently by the International Headache Society in 1988 (HCCIHS 1988) (revised in 2004 [HCCIHS 2004]) . This provides a framework for the standardized diagnosis of migraine.  \nFor this reason, there is little available data on long-term disease course from natural history cohorts which have used this diagnosis classification. In particular, although headache relief treatments, often with over-the-counter analgesic drugs, are widely used, the long-term management of migraine, involving prophylactic treatments and the implementation of strategies to prevent headache evolution to more severe disease and to promote remission, has been explored relatively little. This situation has changed somewhat over recent years with the introduction of standardized guidelines for the diagnosis and treatment of migraine headaches. Moreover, the introduction of triptans as a specific treatment for relief of migraine headaches has stimulated much research into the biology of migraine, leading toa better understanding of its pathophysiology. This articles reviews recent developments in our understanding of migraine and their consequences for improved management of migraine as a chronic disease.  \nTherapeutics and Clinical Risk Management 2008:4(5) 1061–1078 1061  \n© 2008 Dib, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.  \nNatural history of migraine  \nMigraine headache gener","cbCailBXwYLToaPn","https://ap.wps.com/l/cbCailBXwYLToaPn","pdf",313401,1,18,"English","en",105,"# Abstract\n# Natural history of migraine\n## Early onset and under-diagnosis\n## Long-term outcome and remission patterns\n# Chronic headache presentations\n## Transformed migraine and worsening frequency","[{\"question\":\"Why is migraine treatment considered inadequate despite advances in understanding its biology?\",\"answer\":\"Migraine is not a single disease but a syndrome with different underlying pathological conditions, so standard treatment may not fit all patients. Clinical research is needed to determine which patient types benefit from which prophylactic strategies.\"},{\"question\":\"How does the article connect migraine pathophysiology research to current treatments?\",\"answer\":\"It links serotonin’s role in cerebrovascular circulation to the development of triptans for acute relief. It also highlights cortical spreading depression as an early central event, which has increased interest in antiepileptic drugs for migraine prevention.\"},{\"question\":\"What preventive structure does the article propose for migraine prophylaxis?\",\"answer\":\"It proposes four patterns of precipitating factors—adrenergic, serotoninergic, menstrual, and muscular—to structure preventive treatment. It also suggests that early appropriate prophylaxis may improve long-term course and reduce late complications.\"}]","Optimizing prophylactic treatment of migraine: Subtypes and patient matching | PDF",1787689664,45,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"optimizing-prophylactic-treatment-of-migraine-subtypes-and-patient-matching","",{"@graph":36,"@context":85},[37,54,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/optimizing-prophylactic-treatment-of-migraine-subtypes-and-patient-matching/142840/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":62,"encodingFormat":61,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-08-25",true,{"@type":65,"interactionType":66,"userInteractionCount":4},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"Why is migraine treatment considered inadequate despite advances in understanding its biology?","Question",{"text":75,"@type":76},"Migraine is not a single disease but a syndrome with different underlying pathological conditions, so standard treatment may not fit all patients. Clinical research is needed to determine which patient types benefit from which prophylactic strategies.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"How does the article connect migraine pathophysiology research to current treatments?",{"text":80,"@type":76},"It links serotonin’s role in cerebrovascular circulation to the development of triptans for acute relief. It also highlights cortical spreading depression as an early central event, which has increased interest in antiepileptic drugs for migraine prevention.",{"name":82,"@type":73,"acceptedAnswer":83},"What preventive structure does the article propose for migraine prophylaxis?",{"text":84,"@type":76},"It proposes four patterns of precipitating factors—adrenergic, serotoninergic, menstrual, and muscular—to structure preventive treatment. 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