Acute Treatment of Migraine Headaches

ABSTRACT

Optimum acute treatment of migraine requires prevention of headache as a top priority. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical. Successful treatment requires excellent patient–clinician communication enhancing confidence and mutual trust based on patient needs and preferences. Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution. Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy. Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided. Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs. Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes.

KEYWORDS

Migraine-specific - early intervention - central sensitization - migraine-ACT

REFERENCES

• 1 Scary E. The Body in Pain: The Making and Unmaking of the World. New York; Oxford University Press 2001: 140
• 2 Lipton R B, Stewart W F. Acute migraine therapy: do doctors understand what patients with migraine want from therapy?.  Headache. 1999;  39(Suppl 2) S20-S26
• 3 Dodick D W. Applying the benefits of the AwM study in the clinic.  Cephalalgia. 2008;  28(Suppl 2) 42-49
• 4 Headache Classification Subcommittee of the International Headache Society . The international classification of headache disorders, 2nd edition.  Cephalalgia. 2004;  24(Suppl 1) 1-160
• 5 Diamond M L. The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine.  Neurology. 2002;  58(9, Suppl 6) S3-S9
• 6 Lipton R B, Diamond S, Reed M, Diamond M L, Stewart W F. Migraine diagnosis and treatment: results from the American Migraine Study II.  Headache. 2001;  41(7) 638-645
• 7 Lipton R B, Cady R K, Stewart W F, Wilks K, Hall C. Diagnostic lessons from the spectrum study.  Neurology. 2002;  58(9, Suppl 6) S27-S31
• 8 Stewart W F, Lipton R B, Kolodner K. Migraine disability assessment (MIDAS) score: relation to headache frequency, pain intensity, and headache symptoms.  Headache. 2003;  43(3) 258-265
• 9 Ware J E, Bjorner J B, Dahlof C et al.. Development for the headache impact test (HIT) using item response theory (IRT).  Cephalalgia. 2000;  20 309 , (Abstract)
• 10 Kroenke K, Spitzer R L, Williams J B. The PHQ-9: validity of a brief depression severity measure.  J Gen Intern Med. 2001;  16(9) 606-613
• 11 Lipton R B, Hahn S R, Cady R K et al.. In-office discussions of migraine: results from the American Migraine Communication Study.  J Gen Intern Med. 2008;  23(8) 1145-1151
• 12 Buse D C, Rupnow M F, Lipton R B. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life.  Mayo Clin Proc. 2009;  84(5) 422-435
• 13 Maizels M, Burchette R. Rapid and sensitive paradigm for screening patients with headache in primary care settings.  Headache. 2003;  43(5) 441-450
• 14 Dowson A J, Lipscombe S, Sender J, Rees T, Watson D. MIPCA Migraine Guidelines Development Group. Migraine In Primary Care Advisors . New guidelines for the management of migraine in primary care.  Curr Med Res Opin. 2002;  18(7) 414-439
• 15 Dowson A J, Sender J, Lipscombe S et al.. Establishing principles for migraine management in primary care.  Int J Clin Pract. 2003;  57(6) 493-507
• 16 Katsarava Z, Schneeweiss S, Kurth T et al.. Incidence and predictors for chronicity of headache in patients with episodic migraine.  Neurology. 2004;  62(5) 788-790
• 17 Tepper S J, Spears R C. Acute treatment of migraine.  Neurol Clin. 2009;  27(2) 417-427
• 18 Bigal M E, Serrano D, Buse D, Scher A, Stewart W F, Lipton R B. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study.  Headache. 2008;  48(8) 1157-1168
• 19 Bigal M E, Lipton R B. Excessive acute migraine medication use and migraine progression.  Neurology. 2008;  71(22) 1821-1828
• 20 Dodick D W, Schwedt T. Headache: challenging conventional wisdom.  Lancet Neurol. 2009;  8(1) 12-14
• 21 Taylor F R. Migraine headache: options for acute treatment.  Curr Neurol Neurosci Rep. 2005;  5(2) 86-92
• 22 Lipton R B, Stewart W F, Stone A M, Láinez M J, Sawyer J P. Disability in Strategies of Care Study group . Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study: A randomized trial.  JAMA. 2000;  284(20) 2599-2605
• 23 Lofland J H, Kim S S, Batenhorst A S et al.. Cost-effectiveness and cost-benefit of sumatriptan in patients with migraine.  Mayo Clin Proc. 2001;  76(11) 1093-1101
• 24 Halpern M T, Lipton R B, Cady R K, Kwong W J, Marlo K O, Batenhorst A S. Costs and outcomes of early versus delayed migraine treatment with sumatriptan.  Headache. 2002;  42(10) 984-999
• 25 García Rodríguez L A, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs.  Lancet. 1994;  343(8900) 769-772
• 26 Tannenbaum H, Davis P, Russell A S et al.. An evidence-based approach to prescribing NSAIDs in musculoskeletal disease: a Canadian consensus. Canadian NSAID Consensus Participants.  CMAJ. 1996;  155(1) 77-88
• 27 Griffin M R. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury.  Am J Med. 1998;  104 23S-29S
• 28 Fored C M, Ejerblad E, Lindblad P et al.. Acetaminophen, aspirin, and chronic renal failure.  N Engl J Med. 2001;  345(25) 1801-1808
• 29 Lipton R B, Raskin N, Ruoff G, Saper J, Sheftell F, Solomon S. Over-the-counter analgesics and kidney disease.  Am J Kidney Dis. 1996;  27(6) 917-918
• 30 Soldin O P, Tonning J M. Obstetric-Fetal Pharmacology Research Unit Network . Serotonin syndrome associated with triptan monotherapy.  N Engl J Med. 2008;  358(20) 2185-2186
• 31 Shapiro R E, Tepper S J. The serotonin syndrome, triptans, and the potential for drug-drug interactions.  Headache. 2007;  47(2) 266-269
• 32 Evans R W. The FDA alert on serotonin syndrome with combined use of SSRIs or SNRIs and triptans: an analysis of the 29 case reports.  MedGenMed. 2007;  9(3) 48
• 33 Evans R W. More on serotonin syndrome associated with triptan monotherapy.  N Engl J Med. 2008;  359(8) 870 author reply 870-871
• 34 Wenzel R G, Tepper S, Korab W E, Freitag F. Serotonin syndrome risks when combining SSRI/SNRI drugs and triptans: is the FDA's alert warranted?.  Ann Pharmacother. 2008;  42(11) 1692-1696
• 35 American Headache Society Committee on Headache Education. What is “serotonin syndrome” and what should you know about it?. http://Available at: http//www.achenet.org/education/patients Accessed June 25, 2009
• 36 American Headache Society Committee on Headache Education. SSRIs, triptans and serotonin syndrome: what is the risk of serotonin syndrome in migraine?. http://Available at: http//www.achenet.org/education/news/index.asp Accessed June 25, 2009
• 37 Dodick D, Lipton R B, Martin V Triptan Cardiovascular Safety Expert Panel et al.. Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.  Headache. 2004;  44(5) 414-425
• 38 Dodick D W, Martin V T, Smith T, Silberstein S. Cardiovascular tolerability and safety of triptans: a review of clinical data.  Headache. 2004;  44(Suppl 1) S20-S30
• 39 Tepper S J, Millson D. Safety profile of the triptans.  Expert Opin Drug Saf. 2003;  2(2) 123-132
• 40 Headache Consortium US. American Academy of Neurology Headache Guidelines. Available at: http://www.aan.com/professionals/practice/pdfs/gl0087.pdf Accessed June 26, 2009
• 41 Snow V, Weiss K, Wall E M et al.. Pharmacologic management of acute attacks of migraine and prevention of migraine headache.  Ann Intern Med. 2002;  137 840-849
• 42 Bedell A W, Cady R K, Diamond M L et al.. Patient-centered strategies for effective management of migraine. Primary Care Network 2000
• 43 Taylor F, Hutchinson S, Graff-Radford S, Cady R, Harris L. Diagnosis and management of migraine in family practice.  J Fam Pract. 2004 January;  (Suppl) S3-S24
• 44 Mett A, Tfelt-Hansen P. Acute migraine therapy: recent evidence from randomized comparative trials.  Curr Opin Neurol. 2008;  21(3) 331-337
• 45 Cady R K, Sheftell F, Lipton R B et al.. Effects of early intervention with sumatriptan on migraine pain: retrospective analysis of data from three clinical trials.  Clin Ther. 2000;  22 1035-1048
• 46 Pascual J, Cabarrocas X. Within-patient early versus delayed treatment of migraine attacks with almotriptan: the sooner the better.  Headache. 2002;  42(1) 28-31
• 47 Goadsby P J. The ‘Act when Mild’ (AwM) Study: a step forward in our understanding of early treatment in acute migraine.  Cephalalgia. 2008;  28(Suppl 2) 36-41
• 48 Headache Classification Subcommittee of the International Headache Society . The International Classification of Headache Disorders. 2nd Edition.  Cephalalgia. 2004;  24(Suppl 1) 94-97
• 49 Dowson A J, Tepper S J, Baos V, Baudet F, D'Amico D, Kilminster S. Identifying patients who require a change in their current acute migraine treatment: the Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire.  Curr Med Res Opin. 2004;  20(7) 1125-1135
• 50 García M L, Baos V, Láinez M, Pascual J, López-Gil A. Responsiveness of migraine-ACT and MIDAS questionnaires for assessing migraine therapy.  Headache. 2008;  48(9) 1349-1355
• 51 Cevoli S, D'Amico D, Martelletti P et al.. Underdiagnosis and undertreatment of migraine in Italy: a survey of patients attending for the first time 10 headache centres.  Cephalalgia. 2009;  29(12) 1285-1293
• 52 Ferrari M D, Roon K I, Lipton R B, Goadsby P J. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials.  Lancet. 2001;  358(9294) 1668-1675
• 53 Davies G M, Santanello N, Lipton R. Determinants of patient satisfaction with migraine therapy.  Cephalalgia. 2000;  20(6) 554-560
• 54 Lipton R B, Stewart W F, Cady R K et al.. 2000 Wolfe Award. Sumatriptan for the range of headaches in migraine sufferers: results of the Spectrum Study.  Headache. 2000;  40(10) 783-791
• 55 Cady R K, Lipton R B, Hall C, Stewart W F, O'Quinn S, Gutterman D. Treatment of mild headache in disabled migraine sufferers: results of the Spectrum Study.  Headache. 2000;  40(10) 792-797
• 56 Tepper S, Allen C, Sanders D, Greene A, Boccuzzi S. Coprescription of triptans with potentially interacting medications: a cohort study involving 240,268 patients.  Headache. 2003;  43(1) 44-48
• 57 Rapoport A M, Tepper S J. Triptans are all different.  Arch Neurol. 2001;  58(9) 1479-1480
• 58 Rapoport A M, Tepper S J, Bigal M E, Sheftell F D. The triptan formulations: how to match patients and products.  CNS Drugs. 2003;  17(6) 431-447
• 59 Sheftell F D, Feleppa M, Tepper S J, Volcy M, Rapoport A M, Bigal M E. Patterns of use of triptans and reasons for switching them in a tertiary care migraine population.  Headache. 2004;  44(7) 661-668
• 60 Living E. On megrim, sick-headache, and some allied disorders. A contribution to the pathology of nerve storms (1873). Nijmegen, The Netherlands; Arts & Boeve Publishers 1997
• 61 Burstein R, Yarnitsky D, Goor-Aryeh I, Ransil B J, Bajwa Z H. An association between migraine and cutaneous allodynia.  Ann Neurol. 2000;  47(5) 614-624
• 62 Burstein R, Levy D, Jakubowski M, Woolf C J. Peripheral and central sensitization related to headache. In: Olesen J, Welch KMA, Goadsby PJ, Tfelt-Hansen P The Headaches. Philadelphia, PA; Lippincott Williams & Wilkins 2005: 119-126
• 63 Burstein R, Cutrer M F, Yarnitsky D. The development of cutaneous allodynia during a migraine attack: clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine.  Brain. 2000;  123(Pt 8) 1703-1709
• 64 Levy D, Jakubowski M, Burstein R. Disruption of communication between peripheral and central trigeminovascular neurons mediates the antimigraine action of 5HT 1B/1D receptor agonists.  Proc Natl Acad Sci U S A. 2004;  101(12) 4274-4279
• 65 Edelmayer R M, Vanderah T W, Majuta L et al.. Medullary pain facilitating neurons mediate allodynia in headache-related pain.  Ann Neurol. 2009;  65(2) 184-193
• 66 Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia.  Ann Neurol. 2004;  55(1) 19-26
• 67 Burstein R, Jakubowski M. Analgesic triptan action in an animal model of intracranial pain: a race against the development of central sensitization.  Ann Neurol. 2004;  55(1) 27-36
• 68 Burstein R. Almotriptan efficacy in migraine with developing allodynia is as high as the efficacy in migraine without allodynia—but is it the same in migraine with established allodynia?.  Headache. 2009;  49(3) 364-365
• 69 Jakubowski M, Levy D, Kainz V, Zhang X C, Kosaras B, Burstein R. Sensitization of central trigeminovascular neurons: blockade by intravenous naproxen infusion.  Neuroscience. 2007;  148(2) 573-583
• 70 Fox A W, Davis R L. Migraine chronobiology.  Headache. 1998;  38(6) 436-441
• 71 Géraud G, Keywood C, Senard J M. Migraine headache recurrence: relationship to clinical, pharmacological, and pharmacokinetic properties of triptans.  Headache. 2003;  43(4) 376-388
• 72 Dodick D W, Lipton R B, Ferrari M D et al.. Prioritizing treatment attributes and their impact on selecting an oral triptan: results from the TRIPSTAR Project.  Curr Pain Headache Rep. 2004;  8(6) 435-442
• 73 Dodick D W, Martin V. Triptans and CNS side-effects: pharmacokinetic and metabolic mechanisms.  Cephalalgia. 2004;  24(6) 417-424
• 74 Pierce M, Marbury T, O'Neill C, Siegel S, Du W, Sebree T. Zelrix: a novel transdermal formulation of sumatriptan.  Headache. 2009;  49(6) 817-825
• 75 Brandes J L, Kudrow D, Stark S R et al.. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial.  JAMA. 2007;  297(13) 1443-1454
• 76 Sandrini G, Cerbo R, Del Bene E et al.. Efficacy of dosing and re-dosing of two oral fixed combinations of indomethacin, prochlorperazine and caffeine compared with oral sumatriptan in the acute treatment of multiple migraine attacks: a double-blind, double-dummy, randomised, parallel group, multicentre study.  Int J Clin Pract. 2007;  61(8) 1256-1269
• 77 Saper J R. What matters is not the differences between triptans, but the differences between patients.  Arch Neurol. 2001;  58(9) 1481-1482
• 78 Saper J R, Silberstein S, Dodick D, Rapoport A. DHE in the pharmacotherapy of migraine: potential for a larger role.  Headache. 2006;  46(Suppl 4) S212-S220
• 79 Fisher M, Gosy E J, Heary B, Shaw D. Dihydroergotamine nasal spray for relief of refractory headache: a retrospective chart review.  Curr Med Res Opin. 2007;  23(4) 751-755
• 80 Aurora S K, Rozen T D, Kori S H, Shrewsbury S B. A randomized, double blind, placebo-controlled study of MAP0004 in adult patients with migraine.  Headache. 2009;  49(6) 826-837
• 81 Krymchantowski A V, Jevoux Cda C. The experience of combining agents, specially triptans and non steroidal anti-inflammatory drugs, for the acute treatment of migraine–a review.  Recent Patents CNS Drug Discov. 2007;  2 141-144
• 82 Azzopardi T D, Brooks N A. Oral metoclopramide as an adjunct to analgesics for the outpatient treatment of acute migraine.  Ann Pharmacother. 2008;  42(3) 397-402
• 83 Kenney C, Hunter C, Davidson A, Jankovic J. Metoclopramide, an increasingly recognized cause of tardive dyskinesia.  J Clin Pharmacol. 2008;  48(3) 379-384
• 84 Lake III A E. Behavioral and nonpharmacologic treatments of headache.  Med Clin North Am. 2001;  85(4) 1055-1075
• 85 Li Y, Liang F, Yang X et al.. Acupuncture for treating acute attacks of migraine: a randomized controlled trial.  Headache. 2009;  49(6) 805-816
• 86 Farinelli I, De Filippis S, Coloprisco G, Missori S, Martelletti P. Future drugs for migraine.  Intern Emerg Med. 2009;  , June 24 [Epub ahead of print]