Document Type


Publication Date

February 2004


This article has been peer reviewed. It is the authors' final version prior to publication in The Annual Review of Medicine 55:505-518, 2004. The published version is available at Copyright (c) 2004 by Annual Reviews.


The number of migraine treatments and our understanding of migraine pathophysiology are both increasing. Newer treatments are focusing on migraine prevention. Botulinum toxin (BTX) is a potent neurotoxin that has been used primarily for diseases associated with increased muscle activity. Recently the toxin was found to have antinociceptive effects that are probably independent of its muscle-relaxant action. Recent clinical trials support the efficacy of BTX type-A (and possibly also type-B) in the treatment of migraine. The anticonvulsant topiramate was recently shown to be effective for migraine prevention. With the low doses used for this indication, cognitive side effects are less of a concern. Angiotensin (AT) II receptor blockade is a new approach to migraine prevention that was recently examined. The high tolerability of the AT1 receptor blocker candesartan warrants further studies to assess its role in migraine prevention.

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