Dual versus Monotherapy in the Prophylaxis of Acute and Chronic Migraine

DOI: 0.2478/jim-2023-0002


Background: Migraine, a primary headache disorder, is a debilitating condition with reduced productivity, increased disability, and a very high economic burden. The present study aimed to individualize the treatment protocols for episodic and chronic migraine in order to reduce the duration, frequency, and severity of attacks, as well as the disability associated with migraine by comparing monotherapy and dual therapy. Materials and Methods: We conducted a prospective observational study between February 2019 and July 2021. Patients were diagnosed with migraine based on simplified diagnostic criteria. Episodic migraine was present in 62% and chronic migraine in 38% of cases. Disability due to headache was assessed using the Migraine Disability Assessment Score (MIDAS) questionnaire. Prophylactic therapy was individualized, with 210 patients receiving monotherapy (propranolol, flunarizine, or valproic acid) and 190 patients receiving dual therapy (propranolol and flunarizine, or valproic acid and flunarizine). Disability at baseline was graded from I to IV, and improvement after treatment was graded as no recurrence of headache, grade I, grade II, and grade III. Results: After 2–3 months of therapy, we observed significant improvement in the form of reduction in the frequency of attacks and reduction of disability. Patients with grade II disability who received dual therapy showed 100% improvement with no recurrence of headaches. Treatment with valproic acid resulted in no recurrence in 100% of patients with grade I and 85.7% of patients with grade II disability scores. Significant improvement was observed in all grades of disability with dual therapy. Conclusion: Dual prophylactic therapy was more efficient than monotherapy in reducing the frequency, duration, and severity of symptoms in grade III and grade IV patients.