Abstract

Acute management of migraine attacks is often difficult and many patients show to be refractory to treatment. As therapeutic option multiply, it is increasingly important to understand patients's attitudes and preferences regarding various treatment characteristics. A survey of populaton based sample of mig- raineurs indicated that majority of patients consider complete relief of headache, no recurrence, and rapid onset of action as important attributes of acute migraine therapy. In this paper, we also summarize and categorize the common reasons for treatment failure in acute management. That is, the diagnosis is in- complete or incorrect; important exacerbating factors have been missed; pharmacotherapy has been inade- quate; other factors, including unrealistic expectations and comorbidity. Finally we describe the strategy for swithching the way to care when primary pharmacotherapy was inadequate and suggest drugs that could be used for case of refractory to triptans. Korean Journal of Headache 6(1):26-33, 2005