Acute and prophylactic treatment of migraine: practical approaches and pharmacologic rationale.
The antimigraine efficacy of many drugs may be mediated less through their primary modes of action than through the common pathway of serotonergic transmission stabilization. Migraine treatment may be symptomatic, acute/abortive, or prophylactic. Because oral drug absorption is impaired during attacks, parenteral agents are more appropriate for acute therapy. Acute agents include ergots and ergotamine derivatives, narcotics, and sumatriptan succinate. Agents that activate the 5-HT3 receptors must be administered with an antiemetic. Sumatriptan succinate, a specific 5-HT1 receptor agonist, does not necessitate adjunctive antiemetics. Stabilization regimens, such as those using valproate, may favorably alter the natural history of migraine. Sumatriptan succinate is appropriate both for acute attacks and for symptomatic management during stabilization. beta-Blockers, tricyclic antidepressants, and calcium antagonists may be used prophylactically.
Department of Neurology, University of California School of Medicine, San Francisco 94143.
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Raskin
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004087:Dihydroergotamine / Q000494:pharmacology; D004878:Ergotamine / Q000494:pharmacology; D006801:Humans; D007211:Indoles / Q000494:pharmacology; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D010640:Phenothiazines / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D013449:Sulfonamides / Q000494:pharmacology; D018170:Sumatriptan; D014635:Valproic Acid / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007211:Indoles; D010640:Phenothiazines; D017366:Serotonin Receptor Agonists; D013449:Sulfonamides; D004087:Dihydroergotamine; D014635:Valproic Acid; D018170:Sumatriptan; D004878:Ergotamine