Triptans, ergotamine derivatives and nonsteroidal anti-inflammatory drugs are front-line agents used in the acute abortive therapy of migraines. In this article, these medications are reviewed and a treatment algorithm suggested.
Methods
A comprehensive review of the literature from 1990 to 2008 was conducted using PubMed, MEDLINE and The Cochrane Library to explore the underlying pathophysiology of migraines and comparatively assess the acute and chronic treatment options available in their management. The information obtained from all literature searches was further categorized as level 1, 2 or 3 based on pre-defined peer-reviewed criteria.
Conclusion:
This review is able to present a relatively preliminary but practical migraine treatment algorithm. Although there is no standard universal treatment strategy to manage migraine headaches in all patients, this review has been put forth to serve as a clinical guideline to assist health professionals in deciding the most appropriate treatment for migraine headaches.
Get full access to this article
View all access options for this article.
References
1.
LiptonRBScherAIKolodnerKMigraine in the United States: epidemiology and patterns of health care use. Neurology2002;58:885–94.
2.
StovnerL.J.Headache: new concepts, models, and treatments. Lancet Neurol2008;7:11–2.
3.
StovnerLHagenKJensenRThe global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia2007;27:193–210.
4.
Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia2004;24(suppl 1):9–160.
5.
Lantéri-MinetMMassiouHNachit-OuinekhFThe GRIM2005 study of migraine consultation in France I. Determinants of consultation for migraine headache in France. Cephalalgia2007;27:1386–97.
6.
MartinP.R.How do trigger factors acquire the capacity to precipitate headaches?Behav Res Ther2001;39:545–54.
7.
LawrenceE.C.Diagnosis and management of migraine headaches. South Med J2004;97:1069–77.
8.
BeersMHBerkowR.The Merck manual of diagnosis and therapy. Whitehouse Station (NJ): Merck; 1999.
MartinVTGoldsteinJ.A.Evaluating the safety and tolerability profile of acute treatments for migraine. Am J Med2005;118(suppl 1):36–44S.
11.
MayAGoadsbyP.J.The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab1999;19:115–27.
12.
de HoonJNWilligersJMTroostJCranial and peripheral interictal vascular changes in migraine patients. Cephalalgia2003;23:96–104.
13.
GoadsbyPJEdvinssonLEkmanR.Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol1990;28:183–7.
14.
TuxenCJensenKKjeldsenMEffect of neurokinin A on human temporal muscle blood flow. Peptides1989;10:921–4.
15.
DienerHC, RPR100893 Study Group. RPR100893, a substance-P antagonist, is not effective in the treatment of migraine attacks. Cephalalgia2003;23:183–5.
16.
IannettiGDPorroCAPantanoPRepresentation of different trigeminal divisions within the primary and secondary human somatosensory cortex. Neuroimage2003;19:906–12.
17.
BonusoSMaranoEDi StasioEThe frontotemporal region plays a role in the genesis of migraine without aura. Headache1995;35:154–7.
18.
SandykRAwerbuchG.I.The co-occurrence of multiple sclerosis and migraine headache: the serotoninergic link. Int J Neurosci1994;76:249–57.
19.
CassidyEMTomkinsEDinanTCentral 5-HT receptor hypersensitivity in migraine without aura. Cephalalgia2003;23:29–34.
20.
PeroutkaS.J.The pharmacology of current anti-migraine drugs. Headache1990;30(1 suppl):5–11;24–8.
21.
WeillerCMayALimmrothVBrain stem activation in spontaneous human migraine attacks. Nat Med1995;1:658–60.
22.
PanconesiASicuteriR.Headache induced by serotonergic agonists — a key to the interpretation of migraine pathogenesis?Cephalalgia1997;17:3–14.
23.
NicolodiMGaleottiNGhelardiniCCentral cholinergic challenging of migraine by testing second-generation anticholinesterase drugs. Headache2002;42:596–602.
24.
Newman-TancrediAConteCChaputCAgonist activity of antimigraine drugs at recombinant human 5-HT1A receptors: potential implications for prophylactic and acute therapy. Naunyn Schmiedebergs Arch Pharmacol1997;355:682–8.
25.
NamakaMGramlichCRRuhlenDA treatment algorithm for neuropathic pain. Clin Ther2004;26:951–79.
26.
DienerH.C.Consistent efficacy, tolerability, and high levels of satisfaction with almotriptan 12.5 mg when used to treat multiple migraine attacks in routine clinical practice. Headache2005;45:624–31.
27.
SheftellFRyanRPitmanV, Eletriptan Steering Committee. Efficacy, safety, and tolerability of oral eletriptan for treatment of acute migraine: a multicenter, double-blind, placebo-controlled study conducted in the United States. Headache2003;43:202–13.
28.
RyanRGeraudGGoldsteinJClinical efficacy of frovatriptan: placebo-controlled studies. Headache2002;42(suppl 2):S84–92.
29.
Gnecchi-RusconeTBernardXPierrePEffect of naratriptan on myocardial blood flow and coronary vasodilator reserve in migraineurs. Neurology2000;55:95–9.
30.
MathewNTKailasamJMeadorsL.Early treatment of migraine with rizatriptan: a placebo-controlled study. Headache2004;44:669–73.
31.
SheftellFDDahlofCGBrandesJLTwo replicate randomized, double-blind, placebo-controlled trials of the time to onset of pain relief in the acute treatment of migraine with a fast-disintegrating/rapid-release formulation of sumatriptan tablets. Clin Ther2005;27:407–17.
32.
SadovnickADEbersG.C.Epidemiology of multiple sclerosis: a critical overview. Can J Neurol Sci1993;20:17–29.
33.
TepperSJRapoportAMSheftellF.D.Mechanisms of action of the 5-HT1B/1D receptor agonists. Arch Neurol2002;59:1084–8.
34.
BigalMELiptonRBKrymchantowskiA.V.The medical management of migraine. Am J Ther2004;11:130–40.
35.
GoldsteinDJRoonKIOffenWWSelective seratonin 1F (5-HT(1F)) receptor agonist LY334370 for acute migraine: a randomised controlled trial. Lancet2001;358:1230–4.
36.
TatroD.S.Drug interaction facts: the authority on drug interactions. St. Louis (MO): Facts & Comparisons; 2005.
37.
FerrariMDGoadsbyPJRoonKILiptonR.B.Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Cephalalgia2002;22:633–58.
38.
HavankaHDahlofCPopPHEfficacy of naratriptan tablets in the acute treatment of migraine: a dose-ranging study. Naratriptan S2WB2004 Study Group. Clin Ther2000;22:970–80.
39.
SpieringsELRapoportAMDodickDWCharlesworthB.Acute treatment of migraine with zolmitriptan 5 mg orally disintegrating tablet. CNS Drugs2004;18:1133–41.
40.
DowsonAJMassiouHLainezJMCabarrocasX.Almotriptan is an effective and well-tolerated treatment for migraine pain: results of a randomized, double-blind, placebo-controlled clinical trial. Cephalalgia2002;22:453–61.
41.
Lanteri-MinetM.What do patients want from their acute migraine therapy?Eur Neurol2005;53(suppl 1):3–9.
42.
McEvoyG.K.AHFS drug information. Bethesda (MD): American Society of Health-System Pharmacists; 2005.
43.
TrevesTAKuritzkyAHeringRKorczynA.D.Dihydroergotamine nasal spray in the treatment of acute migraine. Headache1998;38:614–7.
44.
DienerHCJansenJPRechesAEfficacy, tolerability and safety of oral eletriptan and ergotamine plus caffeine (Cafergot) in the acute treatment of migraine: a multicentre, randomised, double-blind, placebo-controlled comparison. Eur Neurol2002;47:99–107.
45.
The Multinational Oral Sumatriptan and Cafergot Comparative Study Group. A randomized, double-blind comparison of sumatriptan and Cafergot in the acute treatment of migraine. Eur Neurol1991;31:314–22.
46.
ChristieSGobelHMateosVCrossover comparison of efficacy and preference for rizatriptan 10 mg versus ergotamine/caffeine in migraine. Eur Neurol2003;49:20–9.
47.
GoldsteinJHoffmanHDArmellinoJJTreatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of acetaminophen, aspirin, and caffeine. Cephalalgia1999;19:684–91.
48.
USP DI® volume 1: drug information for the health care professional. Greenwood Village (CO): Thomson MICROMEDEX; 2006.
49.
LaineLConnorsLGReicinASerious lower gastrointestinal clinical events with nonselective NSAID or coxib use. Gastroenterology2003;124:288–92.
50.
The Diclofenac-K/Sumatriptan Migraine Study Group. Acute treatment of migraine attacks: efficacy and safety of a nonsteroidal anti-inflammatory drug, diclofenac-potassium, in comparison to oral sumatriptan and placebo. Cephalalgia1999;19:232–40.
51.
StronksDLTulenJHBussmannHBEffects of naratriptan versus naproxen on daily functioning in the acute treatment of migraine: a randomized, double-blind, doubledummy, crossover study. Headache2003;43:845–52.
52.
MacGregorEADowsonADaviesP.T.Mouth-dispersible aspirin in the treatment of migraine: a placebo-controlled study. Headache2002;42:249–55.
53.
CodispotiJRPriorMJFuMEfficacy of nonprescription doses of ibuprofen for treating migraine headache. A randomized controlled trial. Headache2001;41:665–79.
54.
BoureauFJoubertJMLasserreVDouble-blind comparison of an acetaminophen 400 mg-codeine 25 mg combination versus aspirin 1000 mg and placebo in acute migraine attack. Cephalalgia1994;14:156–61.
55.
SomervilleB.W.Treatment of migraine attacks with an analgesic combination (Mersyndol). Med J Aust1976;1:865–6.
56.
UzogaraESheehanDVManschreckTCJonesK.J.A combination drug treatment for acute common migraine. Headache1986;26:231–6.
57.
AdamE.I.A treatment for the acute migraine attack. J Int Med Res1987;15:71–5.
58.
ColmanIFriedmanBWBrownMDParenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ2008;336:1359–61.
59.
FriedmanBWGreenwaldPBaniaTCRandomized trial of IV dexamethasone for acute migraine in the emergency department. Neurology2007;69:2038–44.
60.
DiamondMCadyR.Initiating and optimizing acute therapy for migraine: the role of patient-centered stratified care. Am J Med2005;118(suppl 1):18–27S.
61.
BrandesJLSaperJRDiamondMTopiramate for migraine prevention: a randomized controlled trial. JAMA2004;291:965–73.
62.
YoonMSSavidouIDienerHCLimmrothV.Evidence-based medicine in migraine prevention. Expert Rev Neurother2005;5:333–41.
63.
CapuanoAVollonoCMeiDAntiepileptic drugs in migraine prophylaxis: state of the art. Clin Ter2004;155:79–87.
64.
NelsonCFBronfortGEvansRThe efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther1998;21:511–9.
65.
ColomboBAnnovazziPOComiG.Therapy of primary headaches: the role of antidepressants. Neurol Sci2004;25(suppl 3):S171–5.
66.
Reveiz-HeraultLCardonaAFOspinaEGCarrilloP.Effectiveness of flunarizine in the prophylaxis of migraine: a metaanalytical review of the literature. Rev Neurol2003;36:907–12 (in Spanish).
67.
SilbersteinSDGoadsbyPJLiptonR.B.Management of migraine: an algorithmic approach. Neurology2000;55(suppl 2):S46–52.
