Practical approaches to migraine management.
Migraine is a recurrent clinical syndrome characterised by combinations of neurological, gastrointestinal and autonomic manifestations. The exact pathophysiological disturbances that occur with migraine have yet to be elucidated; however, cervico-trigemino-vascular dysfunctions appear to be the primary cause. Despite advances in the understanding of the pathophysiology of migraine and new effective treatment options, migraine remains an under-diagnosed, under-treated and poorly treated health condition. Most patients will unsuccessfully attempt to treat their headaches with over-the-counter medications. Few well designed, placebo-controlled studies are available to guide physicians in medication selection. Recently published evidence-based guidelines advocate migraine-specific drugs, such as serotonin 5-HT(1B/1D) agonists (the 'triptans') and dihydroergotamine mesylate, for patients experiencing moderate to severe migraine attacks. Additional headache attack therapy options include other ergotamine derivatives, phenothiazines, nonsteroidal anti-inflammatory agents and opioids. Preventative medication therapy is indicated for patients experiencing frequent and/or refractory attacks.
Diamond
Seymour
S
Diamond Inpatient Headache Unit, Diamond Headache Clinic, St. Joseph Hospital, and Finch University of Health Sciences/The Chicago Medical School, North Chicago, Chicago, Illinois 60614, USA.
Wenzel
Richard
R
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004087:Dihydroergotamine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D011619:Psychotropic Drugs / Q000627:therapeutic use; D055502:Secondary Prevention; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D018170:Sumatriptan / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D011619:Psychotropic Drugs; D017366:Serotonin Receptor Agonists; D014662:Vasoconstrictor Agents; D004087:Dihydroergotamine; D018170:Sumatriptan