Acute Treatment of Migraines

• Published in: CNS drugs Vol. 26; no. 10; pp. 823 - 839
• Main Authors: Da Silva, Arnaldo N., Tepper, Stewart J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2012; Adis International; Springer Nature B.V
• Subjects: Analgesics; Animals; Aspirin; Biological and medical sciences; Blood vessels; Headaches; Humans; Medical sciences; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - drug therapy; Neurology; Neuropharmacology; Neurosciences; Pathophysiology; Patients; Pharmacology. Drug treatments; Pharmacotherapy; Psychiatry; Psychopharmacology; Therapy In Practice; Vascular diseases and vascular malformations of the nervous system; Vasoconstrictor Agents - therapeutic use; United States > US; Naproxen Sodium; Sumatriptan; Migraine; Ketorolac; Zolmitriptan; Nervous system diseases; Toxicity; Acute; Antimigrainous agent; Cardiovascular disease; Review; Cerebral disorder; Vascular disease; Analgesic; Pain; Treatment; Central nervous system disease; Cerebrovascular disease
• ISSN: 1172-7047; 1179-1934
• DOI: 10.2165/11635440-000000000-00000

Migraine is a prevalent and disabling brain disorder that costs billions of dollars annually in direct healthcare costs, and school and work absenteeism and presenteeism. The objective of acute treatment is a cost-effective, rapid restoration of functional ability, with minimal recurrence and adverse effects. The acute treatment of migraine includes specific drugs, which currently all have vasoconstrictive effects (dihydroergotamine and triptans), and nonspecific drugs that include paracetamol (acetaminophen), combination analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), dopamine antagonists, narcotics and corticosteroids. NSAIDs have both peripheral and central effects on reversing migraine, and so may represent the best alternative for patients who cannot use triptans and ergots due to vascular contraindications. Narcotics and habituating medications should be avoided in the acute treatment of migraine, as the risk for transformation to chronic daily headache is excessively high at a relatively infrequent rate of exposure.