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A review of the treatment of primary headaches. Part I: Migraine

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Abstract

Finding the best treatment for a patient's migraine is often a problem in clinical practice since the condition is very common, often debilitating and may prove refractory to therapy. Over recent years, more effective migraine treatments have been found and validated, and the traditional remedies have undergone controlled testing. This article reviews the various therapies available for both the acute treatment and prevention of migraine. Treatments often effective against migraine attacks are: aspirin, analgesics, non steroid antiinflammatory drugs (NSAIDs), ergot derivatives and sumatriptan. Five main classes of prophylactic drug are currently used: beta-blockers, calcium antagonists, serotonin modulators, NSAIDs and ergot compounds. Biofeedback, one of the most efficacious non-pharmacological preventive treatments of migraine, is also discussed.

The variables influencing the choice of acute and preventive treatments, including contriandications and drug availability, are also described in order to provide a practical and up-to-date guide to migraine therapy.

Sommario

L'emicrania è un disturbo che colpisce circa il 15% della popolazione generale risultando spesso debilitante tale da risultare un problema clinico di rilievo soprattutto quando refrattario alla terapia. Questo articolo fornisce una guida razionale ed aggiornata al trattamento di questa malattia, sia per gli attacchi che per la profilassi. Per quanto riguarda gli attacchi i farmaci risultati efficaci nei diversi studi clinici controllati sono l'aspirina, gli analgesici, gli antiinfiammatori non steroidei, gli ergot derivati ed il sumatriptan. I farmaci riconosciuti efficaci nella profilassi dell'emicrania sono identificabili tra 5 principali categorie di sostanze: beta-bloccanti, calcio antagonisti, serotonino-modulatori, antiinfiammatori non steroidei e gli ergot derivati. Tra le terapie non farmacologiche, viene brevemente discussa l'utilità del biofeedback nella prevenzione di alcune forme di emicrania.

Vengono inoltre discusse le numerose variabili che influenzano la scelta del farmaco sia per la profilassi che per l'attacco con le relative controindicazioni.

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References

  1. Agnoli A.:The classification of calcium antagonists by the WHO expert committee: relevance in neurology. Cephalalgia 8 (suppl. 8): 7–10, 1988.

    Article  Google Scholar 

  2. Andrasik F., Oyama O.N., Pacckard P.C.:Biofeedback therapy for migraine. In: Diamond S. (Ed.), Migraine headache prevention and management. New York: Marcel Dekker, pp. 213–238, 1990.

    Google Scholar 

  3. Blanchard E.B., Andrasik F.:Management of chronic headache. Pergamon Press, New York, 1984.

    Google Scholar 

  4. Blanchard E.B., Theobald D.E., Williamson D.A., Silver B., Brown D.A.:Temperature biofeedback in the treatment of migraine headache. Arch. Gen. Psychiatry 35: 581–588, 1988.

    Google Scholar 

  5. Bussone G., Leone M., Peccarisi C. et al.:Double blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 30: 411–417, 1990.

    Article  PubMed  Google Scholar 

  6. Buzzi M.G., Sakas D.E., Moskovitz M.A.:Indomethacin and acetylsalicylic block neurogenic plasma protein extravasation in rat dura mater. Eur. J. Pharmacol. 165: 251–258, 1989.

    Article  PubMed  Google Scholar 

  7. Buzzi M.G., Moskovitz M.A.:The antimigraine drug, sumatriptan (GR 43175), selectively blocks neurogenic plasma extravasation from blood vessels in dura mater. Br. J. Pharmacol 99: 202–206, 1990.

    PubMed  Google Scholar 

  8. Couch J.R. Jr, Hassanein R.:Amitriptyline in migraine prophylaxis. Arch. Neurol. 36: 695–699, 1979.

    PubMed  Google Scholar 

  9. de Lignieres B., Vincenz N., Mauvais-Jarvis P., Mas J.L., Touboul P.J., Bousser M.G.:Prevention of menstrual migraine by percutaneous oestradiol. BMJ 293: 1540, 1986.

    PubMed  Google Scholar 

  10. Diamond S., Kudrow L., Stevens J., Shapiro D.B.:Long-term study of propranolol in the treatment of migraine. Headache 22: 268–271, 1982.

    Article  PubMed  Google Scholar 

  11. Facchinetti F., Fioroni L., Sances G., Romano G., Nappi G., Genazzani A.R.:Naproxensodium in the treatment of premenstrual symptoms: a placebo controlled study. Gynecol. Obstet. Invest. 28: 205–208, 1989.

    PubMed  Google Scholar 

  12. Forsyth P.A., Posner J.B.:Hèadache in patients with brain tumors. Neurology 43: 1678–1683, 1993.

    PubMed  Google Scholar 

  13. Frediani F., Grazzi L., Zanotti A. et al.:Dihydroergocryptine versus dihydroergotamine in migraine prophylaxis: a double-blind clinical trial. Cephalalgia 11: 117–121, 1991.

    Article  PubMed  Google Scholar 

  14. Gallagher M.R.:Emergency treatment of intractable migraine. Headache 26: 74–76, 1986.

    Article  PubMed  Google Scholar 

  15. Goadsby P.J., Gunlach A.L.:Localization of 3H-dihydroergotamine-binding sites in the cat central nervous system: relevance to migraine. Ann. Neurol. 29: 91–94, 1991.

    Article  PubMed  Google Scholar 

  16. Grazzi L., Leone M., Frediani F., Bussone G.:A therapeutic alternative for tension headache in children: treatment and 1-year follow-up results. Biofeedback Self Regul 15: 1–6, 1990.

    Article  PubMed  Google Scholar 

  17. Grazzi L., Bussone G.:Electromyographic-biofeedback for treatment of episodic common migraine: preliminary results of an Italian experimence. AAPB 24th Annual Meeting, 25–30 March, p. 118, 1993.

  18. Hakkarainen H., Vapaatalo H., Gothoni G., Paratainen J.:Tolfenamic acid is as effective as ergotamine during migraine attacks. Lancet, 2: 326–328, 1979.

    Article  PubMed  Google Scholar 

  19. Hanington E., Jones R.J., Amess J.A.L., Wachowicz B.:Migraine: a platelet disorder. Lancet, ii: 720–723, 1981.

    Article  Google Scholar 

  20. Headache Classification Committee of the International Headache Society.Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8: 1–97, 1988.

    Google Scholar 

  21. Hering R., Kuritzky A.:Sodium valproate in the prophylactic treatment of migraine: a double blind study versus placebo. Cephalalgia 12: 81–84, 1992.

    Article  PubMed  Google Scholar 

  22. Jansen I., Tfel-Hansen P., Edvinsson L.:Comparison of the calcium entry blockers nimodipine and flunarizine on human cerebral and temporal arteries: role in cerebrovascular disorders. Eur. J. Clin. Pharmacol. 40: 7–15, 1991.

    Article  PubMed  Google Scholar 

  23. Kangasneimi P., Hedman C.:Metoprolol and propanolol in the prophylactic treatment of classical and common migraine: a double-blind study. Cephalalgia 4: 91–96, 1984.

    Article  PubMed  Google Scholar 

  24. Lane P.L., Ross R.:Intravenous chlorpromazine-preliminary results in acute migraine. Headache 25: 302–304, 1985.

    PubMed  Google Scholar 

  25. Leone M., Frediani F., Patruno G. et al.:IIs nimodipine useful in migraine prophylaxis? Headache 30: 363–365, 1990.

    Article  PubMed  Google Scholar 

  26. Leone M., Grazzi L., La Mantia L. et al.:Flunarizine in migraine: a minireview. Headache 31: 388–391, 1991.

    Article  PubMed  Google Scholar 

  27. Manzoni G.C., Bussone G., Granella F. et al.:Long-term efficacy and safety of flunarizine in the prophylaxis of migraine without aura. Cephalalgia 9 (suppl. 10): 426–427, 1989.

    Google Scholar 

  28. Mikkelsen B.M., Falk J.V.:Prophylactic treatment of migraine with tolfenamic acid. A comparative double-blind crossover study between tolfenamic acid and placebo. Acta Neurol. Scand. 66: 105–111, 1982.

    PubMed  Google Scholar 

  29. Nozaki K., Moskovitz M.A., Boccalini P.:CP-93, 129, sumatriptan, dihydroergotamine block c-fos expression within rat trigeminal nucleus caudalis caused by chemical stimulation of the meninges. Br. J. Pharmacol 106: 409–415, 1992.

    PubMed  Google Scholar 

  30. O'Neill B.P., Mann J.D.:Aspirin prophylaxis in migraine. Lancet ii: 1179–1181, 1978.

    Article  Google Scholar 

  31. Oral Sumatriptan Dose-Defining Study Group.Sumatriptan-an oral dose-defining study. Eur. Neurol. 31: 300–305, 1991.

    Google Scholar 

  32. Pradalier A., Rancurel G., Dordain G., Verdure L., Rascol A., Dry J.:Acute migraine attack therapy: comparison of naproxen sodium and an ergotamine tartrate compound. Cephalalgia 5: 107–113, 1985.

    Article  PubMed  Google Scholar 

  33. Rabkin R., Stables D.P., Levin N.W. et al.:The prophylactic value of propranolol in angina pectoris. Am. J. Cardiol. 18: 370–383, 1966.

    Article  PubMed  Google Scholar 

  34. Raskin N.H.:Treatment of status migrainous: the American experience. Headache 30 (suppl. 2): 550–553, 1990.

    Article  PubMed  Google Scholar 

  35. Rasmussen B.K., Jensen R., Schroll M., Olesen J.:Epidemiology of headache in a general population — A prevalence study. J. Clin. Epidemiol. 11: 11471157, 1991.

    Google Scholar 

  36. Riopelle R.J., McCans J.L.:A pilot study of the calcium antagonist diltiazem in migraine syndrome prophylaxis. J. Can. Sci. Neurol. 9: 269, 1982.

    Google Scholar 

  37. Saito K., Markovitz S., Moskovitz M.A.:Ergot alkaloids block neurogenic extravasation in dura mater: proposed action in vascular headaches. Ann. Neurol. 24: 524–526, 1988.

    Article  Google Scholar 

  38. Selby G., Lance J.W.:Observation on 500 cases of migraine and allied vascular headaches. J. Neurol. Neurosurg. Psychiatry 23: 23–32, 1960.

    PubMed  Google Scholar 

  39. Schoenen J., Maertens de Noordhout A., Timsit-Berthier M., Timsit M.:Contingent negative variation and efficacy of beta-blocking agents in migraine. Cephalalgia 6: 229–233, 1986.

    Article  PubMed  Google Scholar 

  40. Scott A.K.:Dihydroergotamine: a review of its use in the treatment of migraine and other headaches. Clin. Neuropharmacol. 15: 289–296, 1992.

    PubMed  Google Scholar 

  41. Sicuteri F.:Prophylactic and therapeutic properties of 1-methyllysergic acid butanolamide in migraine. Int. Arch. Allerg. 15: 300–307, 1959.

    PubMed  Google Scholar 

  42. SISC: Società Italiana per lo Studio delle Cefalee.Guidelines and recommendations for the treatment of migraine. Func. Neurol. 6: 441–446, 1993.

    Google Scholar 

  43. Solomon G.D., Steel J.G., Spaccavento L.J.:Verapamil prophylaxis of migraine: a double-blind placebo-controlled trial. JAMA 250: 2500–2502, 1983.

    Article  PubMed  Google Scholar 

  44. Sorensen K.V.:Valproate: a new drug in migraine prophylaxis. Acta Neurol. Scand. 78: 346–348, 1988.

    PubMed  Google Scholar 

  45. Sorge F., De Simone R., Marano R. et al.:Flunarizine in prophylaxis of childhood migraine. Cephalalgia 8: 1–6, 1988.

    Article  Google Scholar 

  46. Speight T.M., Avery G.S.:Pizotifen (BC-105): a review of its pharmacological properties and its therapeutic efficacy in vascular headaches. Drug 3: 159–203, 1972.

    PubMed  Google Scholar 

  47. Steiner T.J., Joseph R., Rose F.C.:Migraine is not a platelet disorder. Headache 25: 434–440, 1985.

    PubMed  Google Scholar 

  48. Subcutaneous Sumatriptan International Study Group.Treatment of migraine attacks with sumatriptan. N. Engl. J. Med. 325: 316–321, 1991.

    Google Scholar 

  49. Tfelt-Hansen P., Olesen J.:Effervescent metoclopramide and aspirin (Migravess) versus effervescent aspirin or placebo for migraine attacks: a double-blind study. Cephalalgia 4: 107–111, 1984.

    Article  PubMed  Google Scholar 

  50. Tfelt-Hansen P.:Efficacy of beta-blockers in migraine: a critical review. Cephalalgia 6 (suppl. 5): 15–24, 1986.

    Article  Google Scholar 

  51. Tfelt-Hansen P., Pedersen H.R.:Migraine prophylaxis with 5-HT2 partial agonists and receptor antagonists. In: Olesen J., Saxena P.R. (Eds.), 5-hydroxytryptamine mechanisms in primary headache. New York, Raven Press, pp. 305–310, 1992.

    Google Scholar 

  52. Tfelt-Hansen P., Johnson S.E.:Ergotamine. In: Olesen J., Tfelt-Hansen and Welch K.M.A. (Eds.), The Headaches. Raven press, New York, pp. 313–322, 1993.

    Google Scholar 

  53. Todd P.A., Benfield P.:Flunarizine — a reappraisal of its pharmacological properties and therapeutic use in neurological disorders. Drugs 38: 481–499, 1989.

    PubMed  Google Scholar 

  54. Welch K.M.A., Ellis D.A., Keenan P.A.:Successful migraine prophylaxis with naproxen sodium. Neurology 35: 1304–1310, 1985.

    PubMed  Google Scholar 

  55. Welch K.M.A.:Migraine: a biobehavioral disorder. Arch. Neurol. 44: 323–327, 1987.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Centro Cefalee, Istituto Neurologico Carlo Besta, via Celoria, 20133, Milano, Italy

    Leone M., Grazzi L., D'Amico D., Moschiano F. & Bussone G. MD

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  1. Leone M.
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  2. Grazzi L.
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  3. D'Amico D.
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  4. Moschiano F.
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  5. Bussone G. MD
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Leone, M., Grazzi, L., D'Amico, D. et al. A review of the treatment of primary headaches. Part I: Migraine. Ital J Neuro Sci 16, 577–586 (1995). https://doi.org/10.1007/BF02230907

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  • DOI: https://doi.org/10.1007/BF02230907

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