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Namaka M, Leong C, Grossberndt A, Klowak M, Louizos C, Drummond J, Leligdowicz E, Lichkowski M, Melanson M. Managing Migraines: Options for Acute Abortive Treatment. Can Pharm J (Ott) 2009. [DOI: 10.3821/1913-701x-142.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Triptans, ergotamine derivatives and nonsteroidal anti-inflammatory drugs are front-line agents used in the acute abortive therapy of migraines. In this article, these medications are reviewed and a treatment algorithm suggested. Methods A comprehensive review of the literature from 1990 to 2008 was conducted using PubMed, MEDLINE and The Cochrane Library to explore the underlying pathophysiology of migraines and comparatively assess the acute and chronic treatment options available in their management. The information obtained from all literature searches was further categorized as level 1, 2 or 3 based on pre-defined peer-reviewed criteria. Conclusion: This review is able to present a relatively preliminary but practical migraine treatment algorithm. Although there is no standard universal treatment strategy to manage migraine headaches in all patients, this review has been put forth to serve as a clinical guideline to assist health professionals in deciding the most appropriate treatment for migraine headaches.
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Affiliation(s)
- Mike Namaka
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Christine Leong
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Amy Grossberndt
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Meghann Klowak
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Chris Louizos
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Jenny Drummond
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Ewa Leligdowicz
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Melanie Lichkowski
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Maria Melanson
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
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Grosser K, Oelkers R, Hummel T, Geisslinger G, Brune K, Kobal G, Lötsch J. Olfactory and trigeminal event-related potentials in migraine. Cephalalgia 2000; 20:621-31. [PMID: 11128819 DOI: 10.1111/j.1468-2982.2000.00094.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trigeminal/neuronal hyperexcitability and spreading depression activating the trigemino-vascular system are discussed in migraine-pathophysiology. This study investigated trigeminal and olfactory event-related potentials in migraineurs. METHODS Nasal chemosensitivity was assessed in 19 female migraineurs with or without aura > 72 h before or after an attack and in 19 healthy females employing event-related cortical potentials (ERPs) after specific trigeminal stimulation of nasal nociceptors with short pulses of CO2, and specific olfactory stimulation with H2S. Odour thresholds and odour identification performance were also tested. RESULTS Migraineurs exhibited greater responses to trigeminal stimulation, indicated by significantly larger ERP amplitudes N1. In contrast, olfactory ERP amplitudes P1N1 were significantly smaller in migraineurs. A leave-one-out classification procedure on the basis of these two parameters assigned 76.3% cases correctly. The olfactory ERP amplitude discriminated better between groups than trigeminal ERPs (71.1 vs. 68.4% correct classification). CONCLUSIONS Our data suggest trigeminal hyperexcitability in migraineurs. A general increase of nasal chemosensitivity is not supported because of smaller olfactory ERP amplitudes in migraineurs. Olfactory ERPs discriminate better than trigeminal ERPs between migraineurs and controls, emphasizing the significance of the olfactory system in migraine.
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Affiliation(s)
- K Grosser
- Department of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen Nürnberg, Erlangen, Germany
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