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Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment
Author(s) -
Seggern Randal L.,
Adelman James U.
Publication year - 1996
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1046/j.1526-4610.1996.3608493.x
Subject(s) - medicine , migraine , sumatriptan , metoclopramide , migraine treatment , triptans , dihydroergotamine , narcotic , ibuprofen , intensive care medicine , dosing , anesthesia , acute migraine , pharmacology , alternative medicine , vomiting , placebo , receptor , pathology , agonist
Today's physician has many useful medication options available for acute migraine treatment. There is a wide cost range among these drugs and today’s health care environment demands that cost be factored into the decision process. Effective migraine abortive treatment decreases the costs of repeat dosing and disability. Early use of migraine abortive medication can increase its rapidity of action and effectiveness. Adjunctive medication such as metoclopramide ($0.10) is inexpensive and may improve the effectiveness of the primary abortive medication. Over‐the‐counter medications such as aspirin ($0.02/325 mg), Excadrin· ($0.09/tablet), ibuprofen ($0.04/200 mg), or naproxen sodium ($0.09/220 mg) are inexpensive and effective. “Triple therapy” combining metoclopramide, a nonsteroidal ant‐inflammatory agent, and an ergotamine preparation may improve tolerance and effectiveness of the ergot. Locally compounded dihydroergotamine nasal spray is inexpensive ($0.78/1 mg spray). The cost of using oral sumatriptan can be almost halved by prescribing half of a 50‐mg tablet. Emergency department services are expensive. Huge cost savings occur through self‐controlled administration of oral, rectal, or even intramuscular narcotic medications. Oral narcotic agents such as hydromorphone ($0.42/4 mg) and meperidine ($0.92/200 mg) are generally used in inadequate doses to be effective for severe migraine. Guidelines are given for more effective use of these agents. Sophisticated comparative studies are needed to evaluate, not only the direct costs of medications, but all costs of treatment of an acute migraine attack, as well as Indirect costs to the patient, family, and society.