Q. I have had migraines for over 20 years. For many years now I have been on a beta-blocker for preventive therapy as I failed to tolerate Imitrex® or Topamax®. My headaches usually begin after excessive stress and fatigue, but can occur anytime. In spite of having a very healthy lifestyle, I still have migraines at least twice a month, which unfailingly last three days. Do you have any other ideas for me?

According to the American Migraine Prevalence and Prevention (AMPP) Study1, more than 29 million Americans experience migraines, yet only about 48 percent who have the symptoms of migraine actually receive proper diagnosis. Migraine is a chronic neurologic disorder characterized by recurring attacks of head pain and associated symptoms such as dizziness, nausea, vomiting or extreme sensitivity to light and sound. Below is an overview of the National Headache Foundation's (NHF) Standards of Care for Headache Diagnosis and Treatment which include the U.S. Headache Consortium's recommendations for the proper diagnosis of and treatment options for migraine.

Catapres is the tradename for an alpha agonist, antihypertensive drug generically known as clonidine. This medication is sometimes confused with the anti-anxiety medication Klonopin. In Europe its commercial name is Drixarit®. European studies have shown it effective in the prevention of migraines, especially in food-sensitive migraines. It can also help reduce symptoms for patients withdrawing from narcotics.

The use of beta blockers for the treatment of migraine began in the late '60's, when by accident migraine sufferers being treated for cardiovascular disease found that their migraine attacks lessened. Further research in the '70s led to propranolol being the first of this class of medications to be approved by the FDA for migraine prevention. Subsequently the FDA also approved the use of timolol. Several other beta blockers have been shown in research trials to also be effective for migraine prevention. These include metoprolol, nadolol and atenolol.

Corgard (nadolol) is a beta-blocker that is sometimes effective in the prevention of migraine. Although it is not FDA approved for headache treatment, some studies have shown Corgard to be very effective in decreasing the frequency, duration and severity of migraine.  Because its action lasts for...

Chronic migraine best characterizes those patients with a history of migraine who experience headache more than half the time. This condition was previously called Transformed Migraine. However, transformation requires that the sufferer recall precisely how their headaches have changed over time. This new description will provide a usable definition for medical research studies of new treatment options.