Migraine: A Comprehensive Review of New Treatment Options

Abstract

Headaches are among the most common complaints reported to health care professionals and are classified by the International Headache Society as migraine, tension-type, or cluster, with additional subtypes. Classification and etiology of headache should be determined after thorough review of the patient's history. Once diagnosed, migraine can be treated by preventive or abortive measures. Recent developments add new options, including availability of drugs for intranasal administration (sumatriptan, dihydroergotamine) and 5-HT1B/1D agonists (rizatriptan, zolmitriptan, naratriptan, eletriptan). Although placebo-controlled trials are available, few comparative clinical trials of these agents have been conducted; however, important pharmacologic, pharmacokinetic, and clinical differences exist among the drugs.

Meta-Analysis of Rizatriptan Efficacy in Randomized Controlled Clinical Trials

“…Recurrence of headache following initial pain relief at 2 h is a common problem for all acute migraine treatments, and occurs in approximately a third of attacks (18). The average time to recurrence following treatment with rizatriptan 10 mg in the present studies was 12 h. It has been suggested that there may be differences in the recurrence rates associated with individual ‘triptan’ drugs (19, 20). However, recurrence rates need to be assessed within the context of initial efficacy rates (2).…”

Safety and Efficacy of Eletriptan in the Treatment of Acute Migraine

“…40 Treatment is based on the patient's level of disability and symptoms and on the efficacy of drugs used to treat previous attacks. [40][41][42] Based on data from direct comparisons, one may conclude that high doses of eletriptan, especially 80 mg, provide the greatest benefit in terms of headache and pain-free headache responses, improvement in associated symptoms, ability to function, and patient acceptability. [27][28][29] However, eletriptan 40 mg is the highest available dose in the United States.…”

“…Because of the favorable safety and efficacy profiles of serotonin agonists compared with those of traditional therapies for migraine, their use is pharmacoeconomically justified, although they may be more expensive than traditional therapies. 41,44 Although many researchers have evaluated the effect of migraine treatment on economic issues, only a few specifically assessed eletriptan. In one socioeconomic study, investigators evaluated the effectiveness of eletriptan in reducing the patient-focused burden of migraine, including the total time of incapacitation and the time lost from work during a single attack.…”

Migraine and Its Treatment with 5‐HT1B/1D Agonists (Triptans)

“…Naratriptan has a slower onset of action than that of all other oral triptans but a more favorable adverse effect profile. Naratriptan may be especially appropriate for patients who expe-rience headache recurrence or chest tightness with oral sumatriptan (Weitzel, Thomas, Small, & Goode, 1999). At a dose of 2.5 mg, naratriptan relieves pain in 60% to 65% of patients within 4 hours after administration (Amerge® .…”