Patient outcome in migraine prophylaxis: the role of psychopharmacological agents

Abstract

Introduction:Migraine is a serious illness that needs correct treatment for acute attacks and, in addition, a treatment prophylaxis, since patients with migraine suffer during acute attacks and also between attacks.Methods:A systematic review of the most relevant clinical trials of migraine headache and its epidemiology, pathophysiology, comorbidity, and prophylactic treatment (medical and nonmedical) was carried out using “Medline” and “PsychINFO” from 1973 to 2009. Approximately 110 trials met our inclusion criteria and were included in the current review.Results:The most effective pharmacological treatment for migraine prophylaxis is propranolol and anticonvulsants such as topiramate, valproic acid, and amitriptyline. Nonmedical treatments such as acupuncture, biofeedback, and melatonin have also been proposed. Peripheral neurostimulation has been suggested for the treatment of chronic daily headache that does not respond to prophylaxis and for the treatment of drug-resistant primary headache. The majority of the pharmacological agents available today have limited efficacy and may cause adverse effects incompatible with long-term use.Limitations:The review was limited by the highly variable and often insufficient reporting of the complex outcome data and by the fact that migraine prophylaxis trials typically use headache diaries to monitor the course of the disease. The results of the different studies were also presented in different ways, making comparison of the results difficult.Discussion:An adequate prophylaxis is crucial in reducing disability and preventing the evolution of the problem into a chronic progressive illness. The implications of the present findings were discussed.

Chronic migraine: comorbidities, risk factors, and rehabilitation

“…Furthermore, personality disorders are considered to be a complication for headache management [37,38] and significant headaches represent a complaint of about 60% of patients with personality disorders presenting to the hospital Emergency Department for acute treatment [39].…”

White matter hyperintensities and self-reported depression in a sample of patients with chronic headache

“…Studies in both clinical and community-based settings have demonstrated the association between migraine and a number of specific psychiatric disorders, particularly major affective disorders [17–23]. Previous researchers have hypothesized that the relation between migraine and psychiatric disorder may be bi-directional given that migraine patients have a more than threefold risk of developing depression and the presence of depression is also associated with a greater risk of developing a migraine [21, 24].…”

Quality of Life of Migraine Patients Treated With Combined Propranolol and Topiramate

“…Many of MPs only need treatments for acute attacks but others need prophylactic treatment; indications for prophylactic treatment are present elsewhere (7,8). Appropriate prophylaxis is important for reducing disability and preventing progression of the disease into a chronic progressive illness (9). The goal of treatment in migraine is improving QOL (2, 6).…”