The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image
Open Access

New strategies for the treatment of migraine attacks

  • Sergio Genco1,
  • Domenico D’Amico2,
  • Franca Moschiano3,
  • Maria Pia Prudenzano1,
  • Paola  Mosconi4,
  • Elena Floriani4,
  • Ferdinando Schieroni3 and
  • Gennaro Bussone2Email author
The Journal of Headache and PainOfficial Journal of the Italian Society for the Study of Headaches and the Italian Society of Pain Clinicians2:22


There is no consensus on which treatment strategy should be used in the acute therapy of migraine. A stratified care approach based on patient’s disabilty assessed by a valid instrument (the MIDAS questionnaire) has been proposed. An international controlled study, the DISC trial, showed that stratified care provided better clinical outcomes than step care across attacks or within attacks. An Italian study invited migraine patients with moderate– severe disability to treat 9 attacks according to one of two strategies: stratified care (i.e. triptans from the outset) or step care across attacks (i.e. with drug escalation from non–specific drugs to triptans, if the response was not satisfactory). This study should provide data useful for assessing the optimal treatment strategy in migraine.

Migraine Acute treatmentStep careStratified careTriptans



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