6 Categories of Drugs for Anti-migraine
Migraine is a common clinical chronic neurovascular disease characterized by recurrent, pulsating, severe headache on one or both sides. It lasts 4 to 72 hours. Before the attack, there are often auras such as blurred vision, flashing light, hemianopia, hemilateral and limb numbness. The attack is often accompanied by increased heart rate, pale complexion, nausea, vomiting, photophobia…etc.
Principles of selection and use of drugs for acute migraine
The choice of drugs for the acute phase should be based on the severity of the headache, accompanying symptoms, previous medications, and the patient’s individual condition.
There are Two methods for drug selection:
First, Ladder method: NSAIDs are the first choice for each headache attack, and if the treatment fails, then the migraine-specific treatment drugs are used.
Second, Stratification method: Based on the degree of headache, the degree of functional impairment, and the previous response to drugs, if it is a severe attack, use specific treatment drugs, otherwise use NSAIDs drugs. Drugs should be used in sufficient amounts in the early stages of headaches. Delayed use can reduce the efficacy and increase the proportion of headache recurrence and adverse reactions. Different triptan drugs have slight differences in efficacy and tolerability.
Generally, the use of preventive treatment should be discussed with the patient when the following conditions exist:
(1) The patient’s quality of life, work or school is seriously impaired;
(2) The frequency of seizures is more than 2 times per month;
(3) The acute phase drug treatment is ineffective or the patient cannot tolerate it;
(4) Frequent, prolonged or extremely uncomfortable auras, or migraine cerebral infarction, hemiplegic migraine, or basal migraine subtype;
(5) Use acute treatment for 6-8 times per month for 3 consecutive months;
(6) The migraine attack lasts for more than 72 hours.
According to the report, there are six kinds of drugs that used for anti-migraine
(1) Non-specific drugs: non-steroidal anti-inflammatory drugs; barbiturate sedatives; opioid analgesics.
① Non-steroidal anti-inflammatory drugs: Studies have shown that antipyretic analgesics are effective as first-line drugs for mild and moderate migraine attacks and severe migraine attacks previously used.
② Barbiturate sedatives: can promote sedation, fall asleep, and promote the disappearance of headaches. Because sedatives are addictive, they are only suitable for severe patients who have failed other drug treatments.
③ Opioid drugs: they are addictive and can cause headaches caused by over-application of drugs and induce resistance to other drugs, so they are not routinely recommended. It is only suitable for patients with severe headaches who are ineffective in other drug treatments, and should be used after weighing the pros and cons.
(2) Specific drugs: triptan drugs; ergotamine drugs; calcitonin gene-related peptide receptor antagonists, etc.
① Triptan drugs: Triptan drugs are serotonin 1B/lD receptor agonists, which can specifically control migraine headaches. The efficacy and safety of triptans have been confirmed by large-sample, randomized placebo-controlled trials.
② Ergotamine drugs: Ergotamine drugs have been clinically applied earlier in the treatment of acute migraine attacks, but there are not many randomized controlled trials to judge their efficacy. Ergotamine has the advantages of long drug half-life and low headache recurrence rate, and is suitable for patients with long duration of attacks.
③ Calcitonin gene-related peptide (CGRP) receptor antagonist: CGRP receptor antagonist reduces the symptoms of migraine by returning the dilated meningeal artery to normal, and this process does not cause vasoconstriction.
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