What Is Episodic Migraine Review

| Drug Class | Examples | Best for | Key Caution | |------------|----------|----------|--------------| | | Sumatriptan, rizatriptan, eletriptan | Moderate-severe pain, with nausea | Not in cardiovascular disease; max 2-4 doses/week to avoid MOH | | Gepants (CGRP receptor antagonists) | Ubrogepant, rimegepant | Triptan intolerance, cardiovascular risk | No vasoconstriction; mild nausea possible | | Ditans (5-HT1F agonists) | Lasmiditan | Triptan non-responders, CV risk | Dizziness, fatigue common; no vasoconstriction | | NSAIDs | Ibuprofen, naproxen, diclofenac | Mild-moderate pain | Gastric irritation; limit use | | Anti-emetics | Metoclopramide, prochlorperazine | Severe nausea/vomiting, also analgesic | Extrapyramidal symptoms (rare) | | Non-specific | Acetaminophen (paracetamol) | Mild pain, pregnancy | Hepatotoxicity at high doses | 8.2 Preventive (Prophylactic) Therapy — Reduce Attack Frequency Indicated when: ≥4 migraine days/month, disabling attacks, or acute medication overuse risk.

Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated).

1. Executive Summary Episodic Migraine (EM) is a neurological disease characterized by recurrent, disabling headache attacks occurring on fewer than 15 days per month . It is the most common form of migraine, affecting approximately 90% of the migraine population. Unlike its counterpart, Chronic Migraine (CM), EM allows for symptom-free intervals between attacks. However, EM is not merely "occasional headache"; it is a complex, genetically-influenced brain disorder involving neuronal hyperexcitability, vascular changes, and pain pathway dysregulation. Without proper management, a significant subset of patients with EM can transition to Chronic Migraine —a process known as chronification. 2. Definition & Diagnostic Criteria (ICHD-3) According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), Episodic Migraine is defined by specific features, excluding other headache types. Core Criteria (Must meet A through D): A. At least 5 attacks fulfilling criteria B–D (for migraine without aura).