Appropriate
and effective treatment for migraine first assumes an accurate diagnosis. In
general, the treatment of migraine may be divided into two general pharmacologic
approaches: treatment of the acute attack (abortive, symptomatic) or
preventative (prophylactic ) therapy aimed at preventing the recurrence of
headache. Patients often may need both treatments if their headaches are
frequent and severe. As pointed out by Silberstein and Lipton9
symptomatic treatment is appropriate for most acute attacks and should be used a
maximum of two to three days per week. If attacks occur more frequently,
treatment strategy should emphasize decreasing attack frequency with
prophylactic medications. A full discussion of migraine therapy is reviewed
elsewhere.16,237
Medications
used in acute headache treatment include analgesics, antiemedics, anti-anxiety
agents, nonsteroidal anti-inflammatory drugs (NSAIDs), ergots, steroids, major
tranquillizers, narcotics, and the selective 5HT1 (serotonin)
agonists, the triptans. The original triptan was sumatriptan, originally
introduced in the United States in subcutaneous form but later in oral dosage.238-241
There are now six triptans with different pharmacokinetic profiles and
half-lives.16 Preventive therapy include a broad range of
medications, most notably, anticonvulsants, calcium channel blockers, beta
blockers, antidepressants, serotonin antagonists, and the botulinum neurotoxins.62,242-244
