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Practical approaches to migraine management.
Author(s) -
Diamond S,
Wenzel R
Publication year - 2003
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.1526-4610.2003.03062_13.x
Subject(s) - triptans , migraine , medicine , dihydroergotamine , ergotamine , zolmitriptan , intensive care medicine , headaches , neurology , migraine treatment , sumatriptan , anesthesia , psychiatry , receptor , agonist
CNS Drugs . 2002;16(6):385‐403 Migraine is a recurrent clinical syndrome characterised by combinations of neurological, gastrointestinal and autonomic manifestations. The exact pathophysiological disturbances that occur with migraine have yet to be elucidated; however, cervico‐trigemino‐vascular dysfunctions appear to be the primary cause. Despite advances in the understanding of the pathophysiology of migraine and new effective treatment options, migraine remains an under‐diagnosed, under‐treated and poorly treated health condition. Most patients will unsuccessfully attempt to treat their headaches with over‐the‐counter medications. Few well designed, placebo‐controlled studies are available to guide physicians in medication selection. Recently published evidence‐based guidelines advocate migraine‐specific drugs, such as serotonin 5‐HT(1B/1D) agonists (the Ätriptans') and dihydroergotamine mesylate, for patients experiencing moderate to severe migraine attacks. Additional headache attack therapy options include other ergotamine derivatives, phenothiazines, nonsteroidal anti‐inflammatory agents and opioids. Preventative medication therapy is indicated for patients experiencing frequent and/or refractory attacks. Comment: A nicely written, practical review article which I recommend for medical students, residents, and primary care physicians. SJT