Advertisement
Mayo Clinic Proceedings Home
MCP Digital Health Home

An Overview of the Diagnosis and Pharmacologie Treatment of Migraine

      Migraine, an episodic headache disorder, is one of the most common complaints encountered by primary-care physicians and neurologists. Nevertheless, it remains underdiagnosed and undertreated. Rational migraine treatment necessitates an accurate diagnosis, identification and removal of potential triggering factors, and, frequently, pharmacologie intervention. Effective management also includes establishing realistic expectations, patient reassurance, and education. The choice of medication (abortive, symptomatic) for an acute attack depends on such factors as the severity of the attack, presence or absence of vomiting, time of onset to peak pain, rate of bioavailability of the drug, comorbid medical conditions, and side-effect profile. Effective agents for acute attacks include simple or combination analgesics, nonsteroidal anti-inflammatory drugs, ergot derivatives, selective serotonin agonists, and antiemetics. Opioid analgesics are unnecessary for most patients. The choice of preventive (prophylactic, interval) medication depends primarily on comorbid medical conditions and side-effect profile. Useful preventive agents include ß-adrenergic blockers, calcium channel blockers, tricyclic antide-pressants, anticonvulsant medications, and serotonin antagonists.
      ASA (acetylsalicylic acid), CAD (coronary artery disease), DHE (dihydroergotamine), FDA (Food and Drug Administration), 5-HT (5-hydroxytryptamine), IHS (International Headache Society), MAO (monoamine oxidase), NSAIDs (nonsteroidal anti-inflammatory drugs)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Stewart WF
        • Lipton RB
        • Celentano DD
        • Reed ML
        Prevalence of migraine headache in the United States: relation to age, income, race, and other sociodemographic factors.
        JAMA. 1992; 267: 64-69
        • Lipton RB
        • Stewart WF
        Migraine in the United States: a review of epidemiology and health care use.
        Neurology. 1993; 43: S6-S10
        • Stang PE
        • Osterhaus JT
        • Celentano DD
        Migraine: patterns of healthcare use.
        Neurology. 1994; 44: S47-S55
        • Osterhaus JT
        • Gutterman DG
        • Plachetka JR
        Healthcare resource and lost labor costs of migraine headache in the United States.
        Pharmaco-economics. 1992; 2: 67-76
        • Raskin NH
        On the origin of head pain.
        Headache. 1988; 28: 254-257
        • Silberstein SD
        Advances in understanding the pathophysiology of headache.
        Neurology. 1992; 42: 6-10
        • Lance JW
        Current concepts of migraine pathogenesis.
        Neurology. 1993; 43: Sll-S15
        • Goadsby PJ
        • Gundlach AL
        Localization of 3H-dihydroergotamine-binding sites in the cat central nervous system: relevance to migraine.
        AnnNeurol. 1991; 29: 91-94
        • Weiller C
        • May A
        • Limmroth V
        • Juptner M
        • Kaube H
        • Schayck RV
        • et al.
        Brain stem activation in spontaneous human migraine attacks.
        Nature Med. 1995; 1: 658-660
        • Silberstein SD
        Serotonin (5-HT) and migraine.
        Headache. 1994; 34: 408-417
        • Moskowitz MA
        The neurobiology of vascular head pain.
        Ann Neurol. 1984; 16: 157-168
        • Headache Classification Committee of the International Headache Society
        Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain.
        Cephalalgia. 1988; 8: 1-96
      1. Raskin NH. Diagnosis and treatment of migraine: update on headache; a comprehensive course in mechanisms and management. Presented at the Scottsdale Headache Symposium of the American Association for the Study of Headache; 1995 Jan 20-22; Scottsdale (AZ)

        • Edmeads J
        Headache. 4th ed. Sandoz Canada, Dorval (Quebec)1992
        • Blau JN
        Migraine prodromes separated from the aura: complete migraine.
        BMJ. 1980; 281: 658-660
        • Campbell JK
        Manifestations of migraine.
        Neurol Clin. 1990 Nov; 8: 841-855
        • Silberstein SD
        • Lipton RB
        Overview of diagnosis and treatment of migraine.
        Neurology. 1994; 44: S6-S16
        • Lance JW
        Mechanism and Management of Headache. 5th ed. Butterworth-Heinemann, Boston1993
        • Campbell JK
        • Caselli RJ
        Headache and other craniofacial pain.
        in: Bradley WG Daroff RB Fenichel GM Marsden CD 2nd ed. Neurology in Clinical Practice. Vol 2. Butterworth-Heinemann, Boston1996: 1683-1719
        • Mathew NT
        • Kurman R
        • Perez F
        Drug induced refractory headache-clinical features and management.
        Headache. 1990; 30: 634-638
        • Raskin NH
        Acute and prophylactic treatment of migraine: practical approaches and pharmacologie rationale.
        Neurology. 1993; 43: S39-S42
        • Kaufman J
        • Levine I
        Acute gastric dilatation of stomach during attack of migraine.
        Radiology. 1936; 27: 301-302
        • Volans GN
        The effect of metoclopramide on the absorption of effervescent aspirin in migraine.
        Br J Clin Pharmacol. 1975; 2: 57-63
        • Laska EM
        • Sunshine A
        • Mueller F
        • Elvers WB
        • Siegel C
        • Rubin A
        Caffeine as an analgesic adjuvant.
        JAMA. 1984; 251: 1711-1718
        • Ross-Lee L
        • Eadie MJ
        • Tyrer JH
        Aspirin treatment of migraine attacks: clinical observations.
        Cephalalgia. 1982; 2: 71-76
        • Peters BH
        • Fraim CJ
        • Masel BE
        Comparison of 650 mg aspirin and 1,000 mg acetaminophen with each other, and with placebo in moderately severe headache.
        AmJMed. 1983; 74: 36-42
        • Welch KMA
        Drug therapy of migraine.
        N Engl J Med. 1993; 329: 1476-1483
        • Ryan RE
        A study of midrin in the symptomatic relief of migraine headache.
        Headache. 1974; 14: 33-42
        • Nestvold K
        • Kloster R
        • Partinen M
        • Sulkava R
        Treatment of acute migraine attack: naproxen and placebo compared.
        Cephalalgia. 1985; 5: 115-119
        • Havanka-Kanniainen H
        Treatment of acute migraine attack: ibuprofen and placebo compared.
        Headache. 1989; 29: 507-509
        • Klapper JA
        • Stanton JS
        Ketorolac versus DHE and metoclopramide in the treatment of migraine headaches.
        Headache. 1991; 31: 523-524
        • Saadah HA
        Abortive migraine therapy with oral naproxen sodium plus metoclopramide plus ergotamine tartrate with caffeine.
        Headache. 1992; 32: 95-97
        • Quality Standards Subcommittee of the American Academy of Neurology
        Practice parameter: appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainosus.
        Neurology. 1995; 45: 585-587
        • Perrin VL
        Clinical pharmacokinetics of ergotamine in migraine and cluster headache.
        Clin Pharmacokinet. 1985; 10: 334-352
        • Sanders SW
        • Haering N
        • Mosberg H
        • Jaeger H
        Pharmacokinetics of ergotamine in healthy volunteers following oral and rectal dosing.
        Eur J Clin Pharmacol. 1986; 30: 331-334
        • Horton BT
        • Peters GA
        • Blumenthal LS
        A new product in the treatment of migraine: a preliminary report.
        Mayo Clin Proc. 1945; 20: 241-248
        • Callaham M
        • Raskin N
        A controlled study of dihydroergotamine in the treatment of acute migraine headache.
        Headache. 1986; 26: 168-171
        • Winner P
        • Dalessio D
        • Mathew N
        • Sadowsky C
        • Turkewitz LJ
        • Sheftell F
        • et al.
        Office-based treatment of acute migraine with dihydroergotamine mesylate.
        Headache. 1993; 33: 471-475
        • Raskin NH
        Repetitive intravenous dihydroergotamine as therapy for intractable migraine.
        Neurology. 1986; 36: 995-997
        • Cady RK
        • Wendt JK
        • Kirchner JR
        • Sargent JD
        • Rothrock JF
        • Skaggs Jr, H
        Treatment of acute migraine with subcutaneous sumatriptan.
        JAMA. 1991; 265: 2831-2835
        • Subcutaneous Sumatriptan International Study Group
        Treatment of migraine attacks with sumatriptan.
        N Engl J Med. 1991; 325: 316-321
        • Bates D
        • Ashford E
        • Dawson R
        • Ensink FB
        • Gilhus NE
        • Olesen J
        • for the Sumatriptan Aura Study Group
        • et al.
        Subcutaneous sumatriptan during the migraine aura.
        Neurology. 1994; 44: 1587-1592
        • Oral Sumatriptan International Multiple-Dose Study Group
        Evaluation of a multiple-dose regimen of oral sumatriptan for the acute treatment of migraine.
        Eur Neurol. 1991; 31: 306-313
        • Edmeads J
        Advances in migraine therapy: focus on oral sumatriptan.
        Neurology. 1995; 45: S3-S4
        • Hillis WS
        • Maclntyre PD
        Sumatriptan and chest pain.
        Lancet. 1993; 341: 1564-1565
        • Diamond S
        The use of sumatriptan in patients on monoamine oxidase inhibitors [editorial].
        Neurology. 1995; 45: 1039-1040
        • Bell R
        • Montoya D
        • Shuaib A
        • Lee MA
        A comparative trial of three agents in the treatment of acute migraine headache.
        Ann Emerg Med. 1990; 19: 1079-1082
        • Jones J
        • Sklar D
        • Dougherty J
        • White W
        Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache.
        JAMA. 1989; 261: 1174-1176
        • Gallagher RM
        Emergency treatment of intractable migraine.
        Headache. 1986; 26: 74-75
        • Campbell JK
        • Zagami A
        Status migrainosus.
        in: Olesen J Tfelt-Hansen P Welch KMA The Headaches. Raven Press, New York1993: 405-407
        • Olesen J
        A review of current drugs for migraine.
        J Neurol. 1991; 238: S23-S27
        • Hoffert MJ
        • Couch JR
        • Diamond S
        • Elkind AH
        • Goldstein J
        • Kohlerman NJ
        • et al.
        Transnasal butorphanol in the treatment of acute migraine.
        Headache. 1995; 35: 65-69
        • Diener H-C
        • Limmrofh V
        The treatment of migraine.
        Rev Contemp Pharmacother. 1994; 5: 271-284
        • Diamond S
        • Medina JL
        Double blind study of propranolol for migraine prophylaxis.
        Headache. 1976; 16: 24-27
        • Nadelman JW
        • Phil M
        • Stevens J
        • Saper JR
        Propranolol in the prophylaxis of migraine.
        Headache. 1986; 26: 175-182
        • Ryan Sr, RE
        • Ryan Jr, RE
        • Sudilovsky A
        Nadolol: its use in the prophylactic treatment of migraine.
        Headache. 1983; 23: 26-31
        • Stensrud P
        • Sjaastad O
        Comparative trial of Tenormin (atenolol) and Inderal (propranolol) in migraine.
        Headache. 1980; 20: 204-207
        • Stellar S
        • Ahrens SP
        • Meibohm AR
        • Reines SA
        Migraine prevention with timolol: a double-blind crossover study.
        JAMA. 1984; 252: 2576-2580
        • Kangasniemi P
        • Hedman C
        Metoprolol and propranolol in the prophylactic treatment of classical and common migraine: a double-blind study.
        Cephalalgia. 1984; 4: 91-96
        • Solomon GD
        • Steel JG
        • Spaccavento LJ
        Verapamil prophylaxis of migraine: a double-blind, placebo-controlled study.
        JAMA. 1983; 250: 2500-2502
        • Markley HG
        • Cheronis JC
        • Piepho RW
        Verapamil in prophylactic therapy of migraine.
        Neurology. 1984; 34: 973-976
        • Couch JR
        • Hassanein RS
        Amitriptyline in migraine prophylaxis.
        Arch Neurol. 1979; 36: 695-699
        • Ziegler DK
        • Hurwitz A
        • Preskorn S
        • Hassanein R
        • Seim J
        Propranolol and amitriptyline in prophylaxis of migraine: pharmaco-kinetic and therapeutic effects.
        Arch Neurol. 1993; 50: 825-830
        • Jensen R
        • Brinck T
        • Olesen J
        Sodium valproate has a prophylactic effect in migraine without aura: a triple-blind, placebo-controlled crossover study.
        Neurology. 1994; 44: 647-651
        • Mathew NT
        • Saper JR
        • Silberstein SD
        • Rankin L
        • Markley HG
        • Solomon S
        • et al.
        Migraine prophylaxis with divalproex.
        Arch Neurol. 1995; 52: 281-286
        • Silberstein SD
        • Wilmore LJ
        Divalproex sodium: migraine treatment and monitoring.
        Headache. 1996; 36: 239-242
        • Sicuteri F
        Prophylactic and therapeutic properties of 1-methyl-lysergic acid butanolamide in migraine: preliminary report.
        Int Arch Allergy. 1959; 15: 300-307
        • Curran DA
        • Lance JW
        Clinical trial of methysergide and other preparations in the management of migraine.
        J Neurol Neurosurg Psychiatry. 1964; 27: 463-469
        • Pedersen E
        • Moller CE
        Methysergide in migraine prophylaxis.
        Clin Pharmacol Ther. 1966; 4: 520-526
      2. Physicians' Desk Reference. 49th ed. Medical Economics Data Production Company, Montvale (NJ)1995
        • Miiller-Schweinitzer E
        • Tapparelli C
        Methylergometrine, an active metabolite of methysergide.
        Cephalalgia. 1986; 6: 35-41
        • Mathew NT
        Indomethacin responsive headache syndromes.
        Headache. 1981; 21: 147-150
        • Anthony M
        • Lance JW
        Monoamine oxidase inhibition in the treatment of migraine.
        Arch Neurol. 1969; 21: 263-268
        • O'Neill BP
        • Mann JD
        Aspirin prophylaxis in migraine.
        Lancet. 1978; 2: 1179-1181
        • Stieg RL
        Double-blind study of belladonna-ergotamine-phenobarbital for interval treatment of recurrent throbbing headache.
        Headache. 1977; 17: 120-124
        • Adly C
        • Straumanis J
        • Chesson A
        Fluoxetine prophylaxis of migraine.
        Headache. 1992; 32: 101-104
        • Vijayan N
        Brief therapeutic report: papaverine prophylaxis of complicated migraine.
        Headache. 1977; 17: 159-162