The evolving management of migraine.
OBJECTIVE
To review recent advances in acute and preventive migraine treatment.


RESULTS
The number of migraine drugs continues to expand, allowing for more flexible and tolerable treatment plans. Two new triptans, frovatriptan and eletriptan, and a nasal formulation of zolmitriptan have been recently developed. Eletriptan is effective for acute migraine treatment and may have some pharmacologic and clinical advantages. Frovatriptan has a longer half-life and lower headache recurrence rates compared with other triptans. It may be useful for patients who have prolonged attacks and high headache recurrence rate. Zolmitriptan nasal spray has a rapid onset of action and high efficacy. It should be considered when patients have rapid-onset attacks, especially when associated with severe nausea or vomiting. The butyrophenone neuroleptic droperidol is very effective in aborting acute migraine attacks. Central nervous system side effects are common, however, and the ECG should be monitored. Botulinum toxin type A shows promise as a safe, tolerable and effective drug for migraine prevention, with the unique advantages of almost no systemic adverse events and a long interval between treatments. The anticonvulsant topiramate is effective for migraine prevention. Cognitive side effects are of less concern with the lower doses needed for migraine. The angiotensin converting enzyme receptor blocker candesartan appears to be effective and highly tolerable in the prevention of migraine, but needs to be further evaluated.


CONCLUSIONS
New drugs expand the spectrum of migraine treatment both for the acute attack and for prevention.
Ashkenazi
Avi
A
Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Gibbon Building, Suite #8130, 111 South Eleventh Street, Philadelphia, PA 19107, USA.
Silberstein
Stephen D
SD
D057911:Angiotensin Receptor Antagonists; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D004329:Droperidol / Q000627:therapeutic use; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D023303:Oxazolidinones / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D000077236:Topiramate; D014363:Tryptamines
D057911:Angiotensin Receptor Antagonists; D000927:Anticonvulsants; D014150:Antipsychotic Agents; D002227:Carbazoles; D007211:Indoles; D009465:Neuromuscular Agents; D023303:Oxazolidinones; D011759:Pyrrolidines; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; D000077236:Topiramate; C115647:eletriptan; C089750:zolmitriptan; D005632:Fructose; D019274:Botulinum Toxins, Type A; C108128:frovatriptan; D004329:Droperidol