Migraine prevention trials and optimized acute therapy: translating lessons learned into clinical practice.
Different classes of drugs, discovered by serendipity, have been used successfully for migraine prevention for more than 40 years. The progressive knowledge of migraine pathophysiology, brain hyperexcitability, and the specific neurotransmitter systems involved in pain perception has driven the attempts at targeting two crucial mechanisms: the restoration of nociceptive dysmodulation and the inhibition of cortical hyperexcitability. The success of modern research trials with preventive migraine agents (mainly neuromodulators) and optimized treatment of acute attacks with drug combinations aimed at low serotonergic function, neurogenic inflammation, and central sensitization has translated into better outcomes for patients and physicians. Trials combining preventive migraine agents with nonpharmacologic behavioral headache management have yielded additional benefits over either approach alone. With the clinical application of this updated information from clinical trials, migraine impact on productivity, quality of life, and suffering will certainly be diminished. We hope that these achievements will create a stable path of management to benefit our patients, without interruption, into the foreseeable future.
Krymchantowski
Abouch Valenty
AV
Rua Siqueira Campos 43/1002 Copacabana, Rio de Janeiro, Brazil. abouchkrym@globo.com
Jevoux
Carla da Cunha
Cda C
D000818:Animals; D001521:Behavior Therapy / Q000379:methods / Q000639:trends; D002986:Clinical Trials as Topic / Q000379:methods / Q000639:trends; D006801:Humans; D008881:Migraine Disorders / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D013997:Time Factors
Expert Rev Neurother. 2005 May;5(3):333-41
15938666
Headache. 2005 Jun;45(6):748-50
15953308
Expert Rev Neurother. 2006 Mar;6(3):283-9
16533132
Cephalalgia. 2006 Jul;26(7):871-4
16776704
Expert Rev Neurother. 2005 Mar;5(2):145-7
15853484
Ann Neurol. 1997 Sep;42(3):275-82
9307247
Cephalalgia. 2003 Dec;23(10):961-2
14984228
Headache. 2005 Apr;45 Suppl 1:S33-47
15833089
Cephalalgia. 1999 Apr;19(3):186-7
10234467
Ann Neurol. 2004 Feb;55(2):276-80
14755732
J Neurosci. 2002 Mar 1;22(5):RC213
11880534
Headache. 2005 Sep;45(8):983-91
16109111
JAMA. 2001 May 2;285(17):2208-15
11325322
JAMA. 2007 Apr 4;297(13):1443-54
17405970
Arq Neuropsiquiatr. 2000 Jun;58(2B):428-30
10920403
Headache. 2005 Feb;45(2):156-62
15705122
Lancet. 2006 Oct 14;368(9544):1313-4
17046449
Headache. 2001 Nov-Dec;41 Suppl 1:S3-10
11903534
J Consult Clin Psychol. 1991 Jun;59(3):387-93
2071723
Headache. 2007 Apr;47 Suppl 1:S52-7
17425710