Migraine headache: Options for acute treatment

Taylor, Frederick R.

doi:10.1007/s11910-005-0004-5

Cited by 12 publications

(6 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The early treatment of migraine is therefore a race against central sensitization (13,14) and, in support of this, data from a pivotal open-label study have indicated that triptan therapy may be more efficacious if initiated before the onset of cutaneous allodynia (10). In this study, 53 migraineurs treated their pain either early (1 h after pain onset) or late (4 h after pain onset) on in the attack, with the presence or absence of cutaneous allodynia recorded at the time of treatment.…”

Section: Evolution Of Migraine Painmentioning

confidence: 99%

Early Treatment in Migraine: How Strong is the Current Evidence?

Gendolla

2008

Cephalalgia

View full text Add to dashboard Cite

Over the last 10 years, triptans (serotonin 5-HT(1B/1D) receptor agonists) have proved to be efficacious in treating migraine pain. However, recent evidence suggests that patients are still not receiving optimal pain management, particularly in clinical trials, where triptan treatment is generally not initiated until pain has reached moderate intensity. Pathophysiological evidence indicates that if treatment is initiated at an early stage, while pain is still mild and before the onset of central sensitization, outcomes for patients may be improved. In addition, a small number of clinical trials have been reported in which triptans were taken early (within 1 h of pain onset) or while pain was still mild; although constraints of trial design and data analysis limit definite conclusions, overall the results suggest that this early/mild approach results in more rapid and sustained pain relief. New studies are therefore needed to clarify the clinical benefits of early treatment, whilst taking into account potential risks, such as medication overuse. Ultimately, migraine treatment strategies require optimization in order to meet patient expectations and to reduce the current burden of migraine-associated disability.

show abstract

Section: Evolution Of Migraine Painmentioning

confidence: 99%

Early Treatment in Migraine: How Strong is the Current Evidence?

Gendolla

2008

Cephalalgia

View full text Add to dashboard Cite

show abstract

“…While a wide range of effective pharmacological and nonpharmacological therapies are available for treatment and prevention of headaches, 7,8 current treatment of chronic headache is frequently suboptimal 9‐14 …”

mentioning

confidence: 99%

The Headache Management Trial: A Randomized Study of Coordinated Care

et al. 2008

View full text Add to dashboard Cite

Context.-Headache is a common, disabling disorder that is frequently not well managed in general clinical practice. Objective.-To determine if patients cared for in a coordinated headache management program would achieve reduced headache disability compared with patients in usual care.Design.-A randomized controlled trial of headache management vs usual care. Setting.-Three distinctly different practice sites: an academic internal medicine practice located in a major east coast city, a staff-model managed care organization located in a major west coast city, and a community practice in a medium-sized city in the southeast.Patients.-Individuals 21 years of age or older with chronic tension-type, migraine, or mixed etiology headache and a Migraine Disability Assessment (MIDAS) score greater than 5, not receiving treatment from a neurologist or headache clinic currently or within the previous 6 months and with an intention to continue general medical care at their current location and to continue their present health insurance coverage for the next 12 months.Interventions.-Active intervention is a headache management program consisting of: (1) a class specifically designed to inform patients about headache types, triggers, and treatment options; (2) diagnosis and treatment by a professional especially trained in headache care (based on US Headache Consortium guidelines); and (3) proactive follow-up by a case manager. Participation lasted 6 months. Control patients received usual care from their primary care providers.Main Outcome Measures.-The primary efficacy measure reported in this article is a comparison of MIDAS scores of headache disability between the intervention group and the control group at 6 months. Secondary measures were response at 12 months, general health and quality of life, and satisfaction with headache care.

show abstract

“…For the practitioner prescribing nonspecific treatment, additional potentially important differences exist from migraine-specific therapy ( Table 2). 21 The Disabilities in Strategies of Care (DISC) treatment trial reports that significantly disabled migraine sufferers (MIDAS disability grades II, III, IV of IV) had better outcomes with triptans as initial acute treatment than those stepping through nonspecific treatments. 22 Although nonspecific treatments are low direct cost therapies for both consumer and insurance plans, the DISC trial also instructs that lower total costs are associated with migraine-specific triptan therapy.…”

Section: Selection Of the Appropriate Acute Management: Nonspecific Omentioning

confidence: 99%

“…Lastly, on occasion it appears that an individual may just not respond to a migraine-specific therapy warranting reassessment. 21 Multiple migraine presentations with varying symptoms, creates uncertainty. This variability necessitates versatility in migraine-specific formulations and at times co-mixing this treatment with another analgesic or symptomatic drug.…”

Section: Migraine-specific Selectionmentioning

confidence: 99%

Acute Treatment of Migraine Headaches

Taylor

2010

Semin Neurol

View full text Add to dashboard Cite

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.

show abstract

Migraine headache: Options for acute treatment

Cited by 12 publications

References 42 publications

Early Treatment in Migraine: How Strong is the Current Evidence?

Early Treatment in Migraine: How Strong is the Current Evidence?

The Headache Management Trial: A Randomized Study of Coordinated Care

Acute Treatment of Migraine Headaches

Contact Info

Product

Resources

About