Successful treatments of migraine can be done in five steps. They are:

1. Accurate clinical diagnosis based on the IHS criteria. Full neurological examination should be done on the first visit; the findings are frequently normal. Neuro imaging is not necessary in a typical case.

2. A disability assessment, simple questionnaires like the migraine disability assessment scale (MIDAS) can be used to calculate the extent of disability on the first visit.

3. A stratified care for the sensitive treatment of the headache. Patients who have mild symptoms and disability can be sufficiently treated with acetaminophen, Non-steroidal anti-inflammatory drugs (NSAIDS), or a combination of these. Patients with moderate disability require oral migraine-specific medications. Do not administer vasoconstrictors, such as ergots or triptans, to patients with identified complicated migraine; manage their acute attacks with 1 of the other obtainable agents, such as Non-steroidal anti-inflammatory drugs (NSAIDS). Patients with harsh headaches need subcutaneous, intravenous, or oral formulations of these drugs. The patients may be dehydrated, and adequate hydration is necessary.

4. To individualize treatment on the basis of the patient's summary. No two patients with migraine are the same. Each patient has a single psychosocial environment that heavily influences his or her treatment.

5. Patient education, which is answer to successful long-term management.

Migraine is a chronic neurological disorder that requires a lifestyle modify at some level. Patient education includes teaching the patient to stay away from triggers. Patients should avoid factors that impulsive a migraine attacks for example lack of sleep, fatigue, stress, certain foods, use of vasodilators. Encourage patients to use a daily diary to file the headaches. This is an efficient and inexpensive tool to follow the course of the disease. Changes in hormonal levels, particularly estrogen, may make worse headaches in women. Women may be advised to change, or discontinue use of their oral contraceptives for a trial period. Lupron has been used to simulate menopause to assess the qualified role of estrogenic changes as a trigger. Non-pharmacological treatments consist of relaxation therapy, thermal biofeedback shared with relaxation therapy, electromyography (EMG) biofeedback, and cognitive-behavioral therapy.

Increasing evidence suggests that combining medications with non-pharmacological treatment and lifestyle changes is the most successful method for treating migraine. Migraine prophylaxis indications therapy to prevent migraine is indicated in the following situations are: (a). The patient has more than 2 migraine attacks for every month. (b). The patient has only one attack that last longer than 24 hours. (c) The headaches cause main disruptions in the patient's lifestyle. (d) Abortive therapy fails or is worn-out. (e). The patient has difficult migraine. The goals of preventive therapy are (1) to decrease the attack frequency, severity, and/or duration. (2) To get better responsiveness to acute attacks. (3). To reduce disability.

Classes of prophylactic drugs three classes of medications that are effective for migraine prevention: antiepileptics, antidepressants, and antihypertensives. Modify the choice of medication to the patient profile. Antiepileptics are indicated for migraine prophylaxis and are fine tolerated. The main adverse effects are weight loss. FDA approves antihypertensives such as beta-blockers for migraine prophylaxis, but they should be modified if the patient is young and anxious. It may not be the perfect choice for the elderly or for anyone with depression, thyroid problems, or diabetes. Calcium channel blockers are an additional possible choice of treatment.

Botox may be supportive in patients with intractable migraine headaches that fail to respond to conventional preventive medication. The injections are administered to the scalp and temple and botox injections may decrease the frequency and severity of migraine attacks after 2-3 months of injection. The injections are exclusive and must be administered every 2-3 months to preserve their effectiveness. The most suitable duration of prophylactic therapy has not been determined. In most patients who are getting prophylaxis, therapy must be continued for at least 3-6 months. Prophylaxis should not be considered a failure until it has been given at utmost tolerable dose for at least 30 days.

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