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Acute management of migraine.
J Assoc Physicians India. 2010 Apr; 58 Suppl:21-5.JA

Abstract

Migraine is a brain disease whose principal symptom is episodic intense throbbing pain in the head which is often accompanied by photophobia, phonophobia, nausea and vomiting. Primary objectives of migraine treatment are to abort the acute attacks, treat associated symptoms and prevent future attacks. With a majority of migraine patients being young, they will need a treatment plan to suit their professional work, leisure and reproductive concerns. Non specific anti-migraine drugs like non-steroidal anti-inflammatory drugs, anti-emetics, narcotics, and sympathomimetics are usually helpful in mild to moderate attacks. Specific drugs like triptans and ergots are useful for moderate to severe attacks. In step care approach, the patients are started with the simplest options like simple analgesics first followed by non-steroidal agents, then ergot preparations and eventually triptans if they do not respond. In stratified care approach, the attacks and the patients are stratified according to the severity and therapeutic response. Those with severe disabling episodes are given specific anti-migraine medications like triptans whereas patients with mild or low disability are treated with simple analgesics. Currently, the most favored acute anti-migraine medication is a triptan. At marketed doses all triptans are effective as compared to placebos and generally well tolerated. Amongst them however, rizatriptan 10 mg, eletriptan 80 mg and almotriptan 12.5 mg provide the highest likelihood of consistent success. Triptan related adverse events are usually short lived, mild and clinically insignificant. Ergots are slowly being replaced by triptans. This is because of their adverse side-effects, low bioavailability and high potential for abuse that can lead to overuse headache.

Authors+Show Affiliations

G.B.Pant Hospital, New Delhi, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21049703

Citation

Chowdhury, Debashish. "Acute Management of Migraine." The Journal of the Association of Physicians of India, vol. 58 Suppl, 2010, pp. 21-5.
Chowdhury D. Acute management of migraine. J Assoc Physicians India. 2010;58 Suppl:21-5.
Chowdhury, D. (2010). Acute management of migraine. The Journal of the Association of Physicians of India, 58 Suppl, 21-5.
Chowdhury D. Acute Management of Migraine. J Assoc Physicians India. 2010;58 Suppl:21-5. PubMed PMID: 21049703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute management of migraine. A1 - Chowdhury,Debashish, PY - 2010/11/6/entrez PY - 2010/11/6/pubmed PY - 2010/11/10/medline SP - 21 EP - 5 JF - The Journal of the Association of Physicians of India JO - J Assoc Physicians India VL - 58 Suppl N2 - Migraine is a brain disease whose principal symptom is episodic intense throbbing pain in the head which is often accompanied by photophobia, phonophobia, nausea and vomiting. Primary objectives of migraine treatment are to abort the acute attacks, treat associated symptoms and prevent future attacks. With a majority of migraine patients being young, they will need a treatment plan to suit their professional work, leisure and reproductive concerns. Non specific anti-migraine drugs like non-steroidal anti-inflammatory drugs, anti-emetics, narcotics, and sympathomimetics are usually helpful in mild to moderate attacks. Specific drugs like triptans and ergots are useful for moderate to severe attacks. In step care approach, the patients are started with the simplest options like simple analgesics first followed by non-steroidal agents, then ergot preparations and eventually triptans if they do not respond. In stratified care approach, the attacks and the patients are stratified according to the severity and therapeutic response. Those with severe disabling episodes are given specific anti-migraine medications like triptans whereas patients with mild or low disability are treated with simple analgesics. Currently, the most favored acute anti-migraine medication is a triptan. At marketed doses all triptans are effective as compared to placebos and generally well tolerated. Amongst them however, rizatriptan 10 mg, eletriptan 80 mg and almotriptan 12.5 mg provide the highest likelihood of consistent success. Triptan related adverse events are usually short lived, mild and clinically insignificant. Ergots are slowly being replaced by triptans. This is because of their adverse side-effects, low bioavailability and high potential for abuse that can lead to overuse headache. SN - 0004-5772 UR - https://www.unboundmedicine.com/medline/citation/21049703/Acute_management_of_migraine_ L2 - http://www.diseaseinfosearch.org/result/4811 DB - PRIME DP - Unbound Medicine ER -