DRUG THERAPY OF MIGRAINE
The drug therapy of migraine depends on the severity and frequency of attacks, and the response of individual patients to these drugs. Based on severity, migraine can be grouped into:
Mild migraine whereby migraine attacks are less than one per month and headaches are throbbing but tolerable, lasts up to 8hours and do not incapacitate the individual.
Moderate migraine where the throbbing headache is more intense, lasts for 6- 24hours, nausea, vomiting and other symptoms are more prominent and the patient is functionally impaired. Attacks are one or more per month.
Severe migraine where patients suffer 2-3 or more attacks per month and the throbbing headache usually lasts 12-48hours, usually accompanied by symptoms and patient is greatly incapacitated during the attack.
The strategy mostly adopted in the drug therapy of migraine can be summarized in the table below:
MILD Simple analgesics/ NSAIDs or their combinations (with or without antiemetic)
|MILD||Simple analgesics/ NSAIDs or their combinations (with or without antiemetic)|
|MODERATE||NSAIDs combinations/ ergot alkaloids/ sumatriptan (+antiemetic)|
|SEVERE||Ergot alkaloids/ sumatriptan/ rizatriptan (+antiemetic) + prophylaxis|
Simple analgesics such as paracetamol, aspirin Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, mephenamic acid, indomethacin. These can be taken alone or combined with paracetamol, codeine, diazepam, diphenhydramine or caffeine. They are usually more effective for migraine without aura. Antiemetics such as metoclopramide, domperidone, prochlorperazine.
Drugs used in migraine therapy include:
Ergot alkaloid such as ergotamine Selective 5HT agonists (the triptans) such as sumatriptan, rizatriptan, almotriptan,naratriptan, eletriptan, frovatriptan, zolmitriptan Drugs used in the prophylaxis (prevention) of migraine include:
B-Adrenergic blockers such as propranolol, metoprolol, nadolol
Tricyclic antidepressants such as amitryptilline
Calcium channel blockers such as verapamil
Anticonvulsants such as valproic acid
NON-DRUG THERAPY FOR MIGRAINE
The alternative or complementary treatments for migraine include:
- Physiotherapy which involves giving lifestyle training and advice
- Osteopathy and Chiropractic which involves treatment of the disorders of the spine and neck and their related muscles by manipulation of bones
- Acupuncture which involves the insertion of very thin needles in specific locations in the skin and underlying muscle
- Homoeopathy which involves treating ‘like’ with ‘like’
- Yoga which helps to relieve stress
- Massage and Aromatherapy which helps to relieve tension in the muscles and achieve relaxation
- Counseling and Psychotherapy which helps to identify stresses and find ways of dealing with them
- Alexander technique which involves correcting of bad postures that could trigger pain and illness.
- Biofeedback and Relaxation which helps to recognize the early signs of a migraine and how one’s body respond to them
- Herbal remedies and vitamin supplements such as feverfew (Tanecetum parthenium), Gingko biloba, riboflavin, magnesium, coenzyme Q10
Medical technology or devices used in the treatment and prophylaxis of migraine include:
- Transcranial magnetic stimulation
- Vagal nerve stimulation
- Occipital nerve blocks
- Patent foramen ovale closure
Incase you missed the first part, read here
Compiled by Pharm Mufeedah Kareem-Sulaiman
Vanguard Pharmacy Ltd