Review of Treatment Strategies for Successful Migraine Management: TREATMENT STRATEGIES
Early Treatment of Migraine Attacks
More recently, evidence indicates that early pharmacologic intervention during a migraine attack could provide higher levels of pain relief than later intervention. Retrospective post-hoc analysis of the Spectrum Study results was performed in patients with disabling headaches who were treated while the pain was mild. Results suggest that 50 mg of sumatrip-tan (Imitrex tablet, Glaxo Wellcome Inc) was more effective than placebo for early treatment of migraine attacks. Moreover, pain-free rates were higher for attacks treated with a 50-mg sumatriptan tablet compared to placebo at two and four hours post-dose when pain was rated mild. Currently, no comparable, randomized, placebo-controlled trials support or refute this finding. This observation was not the primary endpoint of the study and, therefore, merits further investigation. Similar findings were reported by the International 311C90 Long-Term Study Group. Also of interest was the lower incidence of adverse effects reported in patients using 50-mg suma-triptan tablets when pain was mild as compared to patients who medicated when pain was moderate to severe. In part, this might be caused by a heightened sensory sensitivity during a migraine attack when pain is moderate to severe. Patients might have an improved tolerance to medications if they treat the migraine attack early, before the occurrence of heightened sensitivity; however, this needs further investigation.
Pain is the most common reason for consultation with primary care physicians, and the most common pain types evaluated are back pain and headaches. Migraine headache is a common complaint, with a higher incidence reported by females. It is estimated that 6% of men and 18% of women currently suffer from this disease. However, the prevalence of migraine headache is probably higher, according to the results of the American Migraine Study. Study results indicated that 71% of men and 59% of women were determined to have migraine headaches from self-reported symptoms but they never received a formal diagnosis.
There’s a dangerous curve in my neighborhood. A dusty road descends a tree-lined hill and turns sharply. The pavement is broken and rutted on one side so that cars traveling in both directions steer onto a single smooth lane. Collisions have been averted (so far), mainly because few cars travel this section of road. However, an accumulation of near-misses has prompted community members to generate plans to prevent a tragedy.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has risen more than 18% in the hospital setting in the last two years. Using data from our Hospital Diagnosis and Therapy Audit (HDTA), comparing the second quarter of 2002 with the same time period in 2000, MediMedia USA, Inc., evaluated patient characteristics such as age, sex, and diagnostic information. Most of the patients taking NSAIDs were women between the ages of 18 and 39 who were in the hospital for an obstetrical diagnosis; however, when the concomitant use of aspirin was examined, the patient profile and diagnoses changed dramatically. Although only 10% of the patients who received NSAIDS received aspirin as well, more than 50% of them were men and more than 90% were over age 40.
