Evaluating the safety and tolerability profile of acute treatments for migraine.
Among the medications that have been used as acute treatments for migraine are nonspecific agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (either single or combination), and narcotics, as well as migraine-specific medications, including ergot alkaloids and triptans (5-hydroxytryptamine 1B/1D agonists). All of these drugs have side effects that vary in type and severity. Side effects of nonspecific medications, including gastrointestinal (GI) and renal effects with NSAIDs and cognitive effects and the potential for abuse with narcotics and butalbital-containing medications, have been documented over time, as these medications have been used for various indications. Side effects of the migraine-specific medications include GI and vascular symptoms with the ergots; for the triptans, they include chest and neurologic symptoms. Although adverse events are reported fairly frequently in patients receiving triptans, they are usually mild, and few patients discontinue therapy because of them. The most serious adverse events are cardiovascular. Because of potential vasoconstrictor effects--mild and transient increases in blood pressure and mild and transient effects on coronary artery tone--triptans as a class are contraindicated in patients with established or clinically suspected cardiovascular disease, specifically ischemic heart disease and uncontrolled hypertension. Other adverse events, including the potential for drug-drug interactions, are less common. Therefore, consideration should be given to the tolerability and safety of medications before their use as abortive medications for the treatment of migraine headache.
Martin
Vincent T
VT
Division of General Internal Medicine, University of Cincinnati, 2624 Clifton Avenue, Cincinnati, Ohio 45221, USA. martindoc@pol.net
Goldstein
James A
JA
D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002319:Cardiovascular System / Q000187:drug effects; D004064:Digestive System / Q000187:drug effects; D004347:Drug Interactions; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use*; D010349:Patient Compliance; D017366:Serotonin Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D017366:Serotonin Receptor Agonists