(Five of the six guideline authors, including Silberstein, disclosed that they had previously served on advisory boards or accepted honoraria or consulting fees from manufacturers of drugs used to treat migraines.)

Migraines which are frequently accompanied by nausea, vomiting, visual disturbances or aura, and sensitivity to light affect about 1 in 10 Americans and can be triggered by certain foods, lack of sleep, stress, jet lag, fasting, and hormonal changes during a womans menstrual cycle. Nearly 40 percent of migraine sufferers have at least four or five headaches a month, and a smaller percentage have chronic migraines defined as having pain at least 15 days a month. Women are also more likely to get them than men.

Doctors especially primary-care physicians who treat most headaches may still have the mindset of prescribing drugs to treat headaches after they set in, rather than for prevention, according to Silberstein.

There may also be reluctance on the part of patients to take medicines every day when migraines come on episodically, said Dr. Elizabeth Loder, an internist in the neurology department at Brigham and Womens Hospital and president-elect of the American Headache Society, which endorsed the guidelines. But the data show that if you have a frequent number of headaches every month, treating them individually can backfire.

Certain medications to relieve migraine pain can become less effective when used too often or could cause rebound headaches caused by withdrawal from the drugs. The triptan class of drugs such as sumatriptan (Imitrex) and frovatriptan (Frova) are the most commonly used drugs to treat pain once a migraine sets in, but the guidelines state that they should be used only occasionally for prevention, say, to avert a monthly menstrual migraine or one likely to occur from a planned religious fast.

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