Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment

Abstract

Today's physician has many useful medication options available for acute migraine treatment. There is a wide cost range among these drugs and today's health care environment demands that cost be factored into the decision process. Effective migraine abortive treatment decreases the costs of repeat dosing and disability. Early use of migraine abortive medication can increase its rapidity of action and effectiveness. Adjunctive medication such as metoclopramide ($0.10) is inexpensive and may improve the effectiveness of the primary abortive medication. Over-the-counter medications such as aspirin ($0.02/325 mg), Excedrin ($0.09/tablet), ibuprofen ($0.04/200 mg), or naproxen sodium ($0.09/220 mg) are inexpensive and effective. "Triple therapy" combining metoclopramide, a nonsteroidal anti-inflammatory agent, and an ergotamine preparation may improve tolerance and effectiveness of the ergot. Locally compounded dihydroergotamine nasal spray is inexpensive ($0.78/1 mg spray). The cost of using oral sumatriptan can be almost halved by prescribing half of a 50-mg tablet. Emergency department services are expensive. Huge cost savings occur through self-controlled administration of oral, rectal, or even intramuscular narcotic medications. Oral narcotic agents such as hydromorphone ($0.42/4 mg) and meperidine ($0.92/200 mg) are generally used in inadequate doses to be effective for severe migraine. Guidelines are give for more effective use of these agents. Sophisticated comparative studies are needed to evaluate, not only the direct costs of medications, but all costs of treatment of an acute migraine attack, as well as indirect costs to the patient, family, and society.

Efficacy and Safety of Acetaminophen in the Treatment of Migraine

“…23 Many prescription medications for migraine are expensive and have potential adverse effects that limit their use by certain individuals. 9,10 This study demonstrates that acetaminophen, a nonprescription analgesic with an excellent safety profile, can effectively treat the pain, disability, and associated symptoms of migraine in a population sample of persons with migraine, excluding individuals who usually require bed rest. Acetaminophen, therefore, represents a safe and cost-effective treatment option for many people with migraine and is available to those who do not seek medical care.…”

“…[5][6][7] When effective, OTC medications offer several advantages over prescription drugs, including easy access, lower cost, and fewer adverse effects. [8][9][10] Despite their advantages and their widespread use, most OTC analgesics are not approved as treatments for migraine. The first OTC agent for migraine in the United States was approved in 1998.…”

Aspirin and tension-type headache

“…In addition, OTC medications have other advantages, such as the absence of cardiovascular contradictions, which are present in triptans. Moreover, OTC drugs could reduce medication costs [37,38].…”

Role of NSAIDs in acute treatment of headache

“…Triptans, NSAIDs and ergotamine respond well to this strategy [Schoenen, 2001]. In early migraine treatment, NSAIDs are widely used, as they are readily available without a prescription making them highly cost effective [Von Seggern and Adelman, 1996;Iannazzo et al, 2003]. The combination of NSAIDs, aspirin (500 mg), acetaminophen (500 mg) and caffeine (130 mg), as compared with sumatriptan (50 mg), was highly efficacious in early migraine abortive treatment .…”