Migraine Pharmacological Therapy

Although the causes of migraine aren't well known, the influence of certain risk factors that support the onset of this type of crisis is well known.

Migraine is the most frequent type of headache and a major cause of disability in our society. This is why it’s important to study migraine pharmacological therapy for acute and preventive crises.

Migraine is a recurring and intense headache, usually located on the side of your head, which manifests as a crisis. It usually manifests with nausea and vomiting, as well as hypersensitivity to light and sound.

There are a few types of migraines:

• Migraine with aura. It’s preceded by visual sensations, called auras, that precede the beginning of a migraine crisis.
• A migraine without aura is the most common type. It’s a form of unilateral, pulsating pain of moderate to severe intensity, aggravated by physical activity.
• Retinal migraine presents as episodes of vision disturbances; a person afflicted with it can only see bright areas or areas of an absence of vision.
• Precursor symptoms of migraine in childhood. Sometimes, children who’ll have migraines in their adulthood experience episodes of recurrent symptoms, such as vomiting, abdominal pain, and dizziness.

Risk factors

Although the causes of migraine aren’t well known yet, we do know the influence of certain risk factors that promote the onset of this type of crisis. Among them:

• Stress is one of the most important risk factors.
• Some food and drinks, such as alcohol, chocolate, coffee, and strong cheeses.
• Intense physical exercise.
• Extreme changes in temperature.
• Some medications, such as nitroglycerin or gemfibrozil.
• Insomnia.
• Certain odors, intense sounds, and bright lights.
• Hormonal changes in women may lead to migraine episodes, during menstruation and menopause, for instance. They may also happen at the beginning of a pregnancy.

Migraine pharmacological therapy

Regarding migraine pharmacological therapy, there are two large groups of drugs:

• Those used for the acute treatment of seizures.
• Preventive or prophylactic ones.

Migraine treatments aim to eliminate pain and the symptoms associated with it. There are three groups of drugs used for this purpose:

• Specific. Ergots and triptans, fundamentally. Ergotamine alkaloids are non-selective agonist drugs of the serotonin 5-HT1 receptor, so they act in different receptors. They do cause some unwanted effects such as dependence and addiction. Triptans are selective agonist drugs of the serotonin 5-HT1 receptor. They exert a vasoconstrictor and anti-inflammatory effect on specific receptors, such as 5-HT1B and 5-HT1D. One of the best-known is sumatriptan.
• Non-specific. NSAIDs and paracetamol. Generally, they’re not usually very effective in acute crises of moderate or severe pain but are recommended in crises with mild to moderate pain.
• Adjuvants. These are drugs to treat associated symptoms, such as antiemetics for the treatment of vomiting.

Prophylactic drugs for migraine pharmacological therapy

When migraine attacks don’t respond adequately to medication, or if they happen so frequently they alter the quality of life of a person, then they can resort to preventive treatments to reduce their intensity, frequency, and duration.

Some drugs used for prophylactic migraines are:

• Propanolol.
• Timolol.
• Metoprolol.
• Sodium valproate.
• Topiramate.
• Botulinum toxin.

Currently, there are new drugs of demonstrated potency and few adverse effects. Some of them act in the peptide pathways related to the calcitonin gene. In fact, they’re monoclonal antibodies. Also, there are other drugs in clinical studies waiting for approval in the near future.

For the proper treatment of migraine, you should combine the appropriate drugs with other non-pharmacological measures. Just like it’s important to have a good treatment for the acute crisis, it’s also important to consider a preventive treatment that helps you reduce the frequency and intensity of your crises.

According to the American Neurological Association, more than 40% of people afflicted by migraines are undiagnosed. Thus, consult a doctor if you have frequent headaches.