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Beyond Monotherapy: Rational Polytherapy in Migraine
Author(s) -
Peroutka Stephen J.
Publication year - 1998
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.1526-4610.1998.3801018.x
Subject(s) - migraine , dopaminergic , medicine , dopamine , pharmacology , inflammation , dopamine receptor , dopamine receptor d2 , neuroscience , anesthesia , immunology , psychology
The past decade has seen significant advances in both the scientific and clinical understanding of migraine. At present, a considerable body of data indicates that migraine is characterized by at least three major pathophysiological features: dopaminergic hypersensitivity, inflammation, and relatively “low” 5‐HT levels. Clinically, blocking dopamine receptors, reducing inflammation, and/or stimulating a subpopulation of 5‐HT, receptors are effective monotherapeutic approaches in many migraineurs. However, monotherapeutic approaches to migraine do not provide rapid, consistent, and complete relief in all migraineurs. Therefore, if monotherapy is suboptimal, it follows logically that concurrent therapy (ie, polytherapy) aimed at modulating two or three of the biological systems should be more efficacious than modulating only a single system. The rationale for the combination use of dopamine antagonists, anti‐inflammatory agents, and 5‐HT 1 agonists are described in the present report.