Medicus, Vol. 30 No. 1 Migrena, 2021.
Review article
Principles of Pharmacological Treatment of Migraine Based on Scientific Evidence
Davor Jančuljak
Abstract
Migraine treatment is tailored to the individual needs of the patient. To avoid random drug selection, a drug that has reliable efficacy in stopping headaches and accompanying symptoms, that is well tolerated and does not affect comorbidities, should be selected. Pharmacological treatment can be directed only to abortive acute therapy if the migraine is rare, has no more severe clinical features and does not cause significant disturbances of daily life activities. If the disability is mild, the first drug of choice may be a nonsteroidal antirheumatic, simple or combined analgesic. In case of severe disability, a specific analgesic from the triptan class can be given immediately, which is also given in case of the first line failure of acute treatment in milder migraine. Prophylactic treatment of migraine should be initiated with frequent episodic and chronic forms of migraine and failure of acute therapy documented by the headache diary. The first line of treatment according to the availability of drugs in Croatia are oral nonspecific prophylactics: beta-blockers (propranolol and metoprolol) and anticonvulsant (topiramate), and in the second line tricyclic antidepressant (amitriptyline). If therapy fails after two attempts at treatment with two different oral prophylactics in patients with at least 4 days of migraine per month, specific prophylactic therapy should be prescribed according to professional guidelines - monoclonal antibodies to calcitonin gene-related peptide (CGRP) (fremanezumab or galcanezumab) / CGRP receptor (erenumab). Specific migraine prophylactics have an advantage over non-specific ones: easy to use, fast onset of action, consistent efficacy, better tolerability and safety profile.
Keywords
migraine; pharmacotherapy; evidence-based medicine
Hrčak ID:
257523
URI
Publication date:
17.5.2021.
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