Open AccessChronic headache treatment: can we always follow international guidelines?
Author(s) -
Н. В. Латышева
Publication year - 2019
Publication title -
medicinskij alfavit
Language(s) - English
Resource type - Journals
eISSN - 2949-2807
pISSN - 2078-5631
DOI - 10.33667/2078-5631-2019-3-24(399)-5-9
Subject(s) - mirtazapine , venlafaxine , medicine , tolerability , migraine , amitriptyline , antidepressant , chronic migraine , depression (economics) , intensive care medicine , psychiatry , pharmacology , adverse effect , anxiety , macroeconomics , economics
International guidelines on the prevention of migraine recommend the use of five main classes of medications: beta-blockers, antiepileptics, antidepressants (amitriptyline and venlafaxine), angiotensin receptor antagonists and botulinum toxin type A. Chronic tension-type headache (CTTH) guidelines are even more limiting and contain only amitriptyline, venlafaxine and mirtazapine. However, long-term intake of these medications is substantially limited by their tolerability issues. Moreover, most recommended medications cannot control the most frequently observed comorbidities, where depression plays the most important role in treatment selection, efficacy and long-term prognosis. This paper reviews the current migraine and CTTH prevention guidelines and complexities that physicians encounter with their use. The paper also includes a case series of treating chronic headache with a new multimodal antidepressant vortioxetine.