• April 26, 2024

There is evidence that there are drugs for him treatment of the acute attack of migraine of first and second line. Beyond the choice of medication, the important thing is in the strategy of the medication.

This treatment of first and second line refers to the initial use, in acute events of any intensity, of safe, effective and cheap drugs, for example, Nonsteroidal anti-inflammatory drugs (NSAIDs) .

If the initial medication fails, a second line specific for migraine is used. Depending on the intensity of the crisis migraine , in case the patient does not respond to the NSAID , you must use specific medications for migraine (triptans, DHE) ".

Oral combinations of opioids and butorphanol can be considered in the migraine acute when sedation is not a risk. The treatment should be reevaluated regularly. When the attack occurs with nausea or threw up treat these symptoms with antiemetic .

Preventive treatment

The indications accepted for the preventive treatment include:

1. Two or more attacks per month that produce disability lasting 3 or more days per month.

2. Acute treatment contraindicated or there is no response to it.

3. Use of "abortive" medications of the crisis more than 2 times per week.

4. Presence of conditions migraine uncommon, such as hemiplegic migraine, migraine with prolonged aura or secondary infarction to migraine .

Other factors that must be taken into account are the adverse effects of acute treatment, patient preference and cost. Behavioral therapy and other non-pharmacological strategies for prevention may be useful.

Antidepressants

The amitriptyline and the Mirtazapine they are the most studied drugs and they are the only ones in which there is evidence of efficacy in the prevention of crises. The most effective doses in clinical trials varied from 30 to 150 mg / d for amitriptyline and 15 to 30 mg / d for mirtazapine.

The side effects more frequent with the use of antidepressants Tricyclics, including amitriptyline and nortriptyline, were drowsiness , increase of weight and anticholinergic symptoms.

Anticonvulsants

There is evidence of the effectiveness of topiramate . In the case of sodium valproate, adverse effects include increase of weight , lost of hair , tremor and its potential teratogenicity, as neural tube defects. They are useful in patients with prolonged or atypical aura.

For most patients migraineurs the NSAID they are the first line treatment for the crisis of pain . In case patients do not respond, specific medications are suggested for the migraine (triptans, DHE) .

Oral combinations of opioids Y butorphanol can be considered in the migraine acute when the sedation and the possible abuse do not represent a risk.

It is necessary to educate about the control of acute crises and preventive treatment, as well as to formulate a second medication plan that must be reevaluated periodically.

Although there are many drugs available for treatment preventive of the migraine , only a few have Proven efficiency .

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