Advances in migraine management
Donald G. Vidt, MD
Todd A. Lewis, DO
Glen D. Solomon, MDAddress reprint requests to G.D.S., Department of Internal Medicine, A30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
New drugs and better understanding of the pathogenesis of migraine are improving the outlook for patients with this debilitating disorder. This paper reviews recent advances and outlines our approach.KEY POINTS
Rational treatment of migraine begins with a detailed history to ascertain the frequency and severity of attacks and to identify “triggers” that can be eliminated.
Nonsteroidal anti-inflammatory drugs, isometheptene mucate, ergotamine, and metoclopramide remain the first-line agents to treat acute attacks; patients whose symptoms do not respond to these drugs may be candidates for subcutaneous sumatriptan or dihydroergotamine. Inhalable preparations of these drugs, when they become available, should simplify their use.
Patients whose attacks are frequent or interfere with their life-style should be offered prophylactic treatment with beta blockers without intrinsic sympathomimetic activity or calcium antagonists; nonsteroidal anti-inflammatory drugs, valproate, antidepressants, and biofeedback also may be used.
Corticosteroids and dihydroergotamine are mainstays of treatment for prolonged or intractable migraine.