Treatment of the Acute Migraine Attack Current Status

Wilkinson, Marcia

doi:10.1046/j.1468-2982.1983.0301061.x

Cited by 27 publications

(17 citation statements)

References 32 publications

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“…Lance (1981) recommended the administration of metoclopramide before the intake of an ergot derivative in order to allow a faster gastric absorption, which is impaired during a migraine attack. Wilkinson (1983) reported that 61% of her patients had total or significant relief of migraine following a regimen that included a dopamine antagonist, a simple analgesic, and an attempt to sleep. In the remaining patients, an ergot preparation was added and resulted in a total efficacy rate of 91%.…”

Section: Resultsmentioning

confidence: 99%

The use of combination therapies in the acute management of migraine

Krymchantowski¹

2006

Neuropsychiatric Disease and Treatment

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Background and objectives:Migraine is a highly prevalent neurological disorder with multiple peripheral and central mechanisms. Targeting a single mechanism for treating individual attacks as well as for performing the prophylaxis has been shown to be only partially effective. Recently, the role of combining agents for acute migraine treatment has gained attention and the combination of a triptan plus a non-steroidal anti-inflammatory drug (NSAID) has demonstrated better efficacy. This review focuses on the fundamentals of treating migraine attacks with two or more agents, and emphasizes the characteristics of the recently approved fixed combination sumatriptan-naproxen. Methods: A PubMed search using the terms "migraine", "treatment", "acute", "triptans", "non-steroidal anti-inflammatory drugs", "sumatriptan", "naproxen", and "combination" was used. In addition, abstracts presented in the major meetings of the American Headache and the International Headache Societies along with the American Academy of Neurology were also evaluated. Results: Although most of the few studies encountered were not controlled, there is a clear trend for better efficacy in combining triptans with NSAID. Additionally, the results of two recent large and controlled studies using fixed combinations of sumatriptan (50 mg and 85 mg) with 500 mg naproxen sodium confirm the initial observations of the clear superiority of this combination over the use of each agent alone. The differences in the endpoints 24-hour painrelief response as well as pain-free and pain-relief parameters at 2-hour time-point are the most noticeable efficacy measures. Tolerability was not different between studied drugs. Conclusions: Combining triptans with NSAID and other agents for the acute treatment of migraine suggests better outcome efficacy measures than the use of single agents. The fixed combination of sumatriptan and naproxen sodium offers improved 2-hour and 24-hour benefits over monotherapy with each one these options. Recently issued FDA approval for marketing the combination (sumatriptan 50 mg-naproxen 500 mg) emphasizes the usefulness and safety of this new treatment for migraine attacks.

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Section: Resultsmentioning

confidence: 99%

The use of combination therapies in the acute management of migraine

Krymchantowski¹

2006

Neuropsychiatric Disease and Treatment

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“…Wilkinson reported that 61% of her patients had total or significant relief of migraine following a regimen that included a dopamine antagonist, a simple analgesic, and an attempt to sleep. In the remaining patients, an ergot preparation was added and resulted in a total efficacy rate of 91% [38]. The combination of dihydroergotamine (DHE) plus prochlorperazine administered intravenously revealed to be a highly effective emergency room scheme as proposed by Callaham and Raskin [39].…”

Section: Discussionmentioning

confidence: 99%

Acute treatment of migraine. Breaking the paradigm of monotherapy

Krymchantowski

2004

BMC Neurol

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BackgroundMigraine is a highly prevalent disorder. The disability provoked by its attacks results in suffering as well as considerable economic and social losses. The objective of migraine acute treatment is to restore the patient to normal function as quickly and consistently as possible. There are numerous drugs available for this purpose and despite recent advances in the understanding of the mechanisms and different biological systems involved in migraine attacks, with the development of specific 5-HT agonists known as triptans, current options for acute migraine still stand below the ideal.DiscussionMonotherapeutic approaches are the rule but up to one third of all patients discontinue their medications due to lack of efficacy, headache recurrence, cost and/or side effects. In addition, a rationale has been suggested for the development of polytherapeutic approaches, simultaneously aiming at some of the biological systems involved. This paper reviews the fundamentals for this changing approach as well as the evidence of its better efficacy.ConclusionAs a conclusion, most of the patients with a past history of not responding (no pain-free at 2 hours and/or no sustained pain-free at 24 hours) in at least 5 previous attacks should undergo a combination therapy suiting to their individual profile, which must include analgesics or non-steroidal anti-inflammatory agents plus a triptan or a gastro kinetic drug. The three-drug regimen may also be considered. In addition, changing the right moment to take it and the choice for formulations other than oral has also to be determined individually and clearly posted to the patient.

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“…Although the support was largely empirical, nonspecific agents (NSAIDs) and migraine-specific drugs (ergots) appeared to exhibit greater efficacy when used early in the course of an acute attack. Furthermore, nonpharmacologic therapies such as rest, application of ice, and relaxation strategies have been shown to be effective when instituted early in the course of a migraine attack [5,Class II].…”

Section: Introductionmentioning

confidence: 99%

Intercepting migraine: Results of early therapy with nonspecific and migraine-specific agents

Kaniecki

2006

Curr Treat Options Neurol

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Migraine is a pervasive neurologic disorder characterized by recurrent attacks of disabling headache. Despite significant morbidity with impact that may be physical, emotional, social, and economic, treatment of these attacks is often delayed. Patients frequently delay therapy until the more severe or "textbook" symptoms arise, often mistaking the earliest stages as representative of "tension" or "sinus" headaches. Clinicians may recommend deferral of treatment until the more severe levels of pain are seen, perhaps in a misguided attempt to conserve pharmaceutical resources. Patients and clinicians seem more comfortable with perspectives of "being sure it's a migraine" and "not wasting the medication on milder headaches." Therefore, patients and clinicians must learn the latest lessons in migraine: 1) mild migraine usually progresses to more severe levels if left untreated, 2) early treatment is more effective than delayed treatment, 3) early treatment may result in lower rates of adverse events and headache recurrence, and 4) early treatment is cost effective. As clinicians advocate the early treatment of migraine in its mild phase, evidence to support this recommendation has finally become available. I educate my migraineurs to consider each typical headache to be a version of migraine. Most patients with migraine will experience "little" headaches that they often mislabel as tension, sinus, regular, stress, or normal headaches. Instead of these terms, I have them consider their attacks as "small migraines" and "big migraines," with the smaller headaches often evolving into the bigger episodes. Given such a foundation, I advise them to treat at the beginning of the headache, perhaps earlier than they would have previously identified it as a migraine. They must capture the attack while it "whispers migraine" instead of delaying until the attack "shouts migraine." Early treatment of migraine is successful for most patients. However, there are situations in which treatment of the mild phase is not advisable or possible. In patients with frequent or daily migraine, treatment must be reserved for the most disabling attacks. We must advise treatment as soon as the migraine becomes moderate to severe. Certain patients, or certain headaches in some patients, may not progress through a mild phase, perhaps because of rapid escalation or because migraine is already severe upon awakening. Here we encourage migraineurs to treat as soon as possible, often with parenteral formulations of medication. The reaction of the patient (speed of dosing) and the action of the medication (speed of onset of the drug) will ultimately play roles in the successful interception of each attack.

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Treatment of the Acute Migraine Attack Current Status

Cited by 27 publications

References 32 publications

The use of combination therapies in the acute management of migraine

The use of combination therapies in the acute management of migraine

Acute treatment of migraine. Breaking the paradigm of monotherapy

Intercepting migraine: Results of early therapy with nonspecific and migraine-specific agents

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