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J Korean Med Assoc > Volume 50(10); 2007 > Article
Chung: Drug Therapy for Migraine

Abstract

Migraine significantly disturbs the quality of life of the patients by causing severe throbbing headache associated with neurological, autonomic, and gastrointestinal symptoms. Management of migraine starts from the correct diagnosis based on the classification proposed by the International Headache Society in 2004. Treatment failure and medication overuse and abuse commonly result from misdiagnosis of specific type of headache. Treatment includes: ① nonpharmacological therapy (patient education, regular exercise, abstinence of caffeine and alcohol drinking, avoidance of fasting, and regular sleep), ② acute pharmacological therapy (simple analgesics, NSAIDs, ergotamines, triptans, etc.), and ③ prophylactic pharmacological therapy (β-blockers, calcium channel blockers, antidepressants, and anticonvulsants). Because individual drugs have their unique properties and drug interactions, careful selection and combination of the drugs must be made on the basis of the patient's migraine type, associated symptoms, and comorbidities. One of the complications of migraine drug therapy is transformation of episodic migraine into chronic daily headache that is caused by abuse or overuse of anti-migraine drugs. So the correct diagnosis of migraine and appropriate pharmacological and non-pharmacological treatments are of utmost importance in improving the patient's quality of life and prevention of medication-overuse headache.

References

1. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Transformed migraine and medication overuse in a tertiary headache centre-clinical characteristics and treatment outcomes. Cephalalgia 2004;24:483-490.

2. Ferrari A, Sternieri E, Ferraris E, Bertolini A. Emerging problems in the pharmacology of migraine: interactions between triptans and drugs for prophylaxis. Pharmacol Res 2003;48:1-9.

3. Goadsby PJ, Lipton RB, Ferrari MD. Migraine. Current understanding and treatment. N Engl J Med 2002;346:257-270.

4. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia 2004;24:S1. 9-160.

5. Landy SH, Lobo BL. Migraine treatment throughout the lifecycle. Expert Rev Neurotherapeutics 2005;5:343-353.

6. Loder E, Biondi D. General principles of migraine management. The changing role of prevention. Headache 2005;45:S1. 33-47.

7. Silberstein SD, Goadsby PJ. Migraine: preventive treatment. Cephalalgia 2002;22:491-512.

Table 1
Diagnostic criteria of migraine
jkma-50-917-i001-l.jpg
Table 2
Pharmacokinetic properties of triptans
jkma-50-917-i002-l.jpg


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