In a new paper published in the Canadian Medical Association Journal (CMAJ), researchers examine migraine diagnosis and acute therapy. According to the researchers, migraine therapy should provide immediate pain and symptom relief, avoid repeated occurrences, and restore patient function.
“Ideally, treatment should be self-administered, effective, well tolerated, and affordable, with minimal redosing,” the article’s authors said.
Migraines were the leading cause of disability among women aged 15 to 49 years old in 2019, impacting three times as many women as men (18% and 6%, respectively). Migraines were ranked as the world’s second biggest cause of disability among men and women of all ages.
Migraine episodes can have five distinct phases: prodrome, aura, headache, postdrome, and interictal, however many people do not experience each phase in the precise sequence listed. Migraines are further classified into six types: migraine without aura, migraine with aura, chronic migraine, migraine complications, probable migraine, and episodic migraine syndromes. Patients frequently suffer various headache phenotypes.
Migraines can be checked or scanned for utilizing imaging, but without the evidence of red flags or abnormalities in a neurologic evaluation, doctors do not advocate frequent imaging. They feel that imaging can result in inadvertent discoveries that cause patient concern and unneeded investigations.
To understand diagnostic and medications used for successful care, researchers evaluated original papers and clinical practice recommendations published in 2021. Experts advocate a tiered strategy to treating acute migraines based on their findings, advising patients to try multiple treatment choices and/or combine different classes of drugs.
They also advise patients to learn how to measure their level of functional impairment during a migraine. This may lead them to base their selections on a well-planned treatment strategy.
When selecting an oral preventive medicine, the authors suggest advise to “start low and go slow.” The team advises patients and practitioners to consider comorbidities that may impair migraine drug efficacy.
“Guidelines from the Canadian Headache Society and the American Headache Society both indicate that acetaminophen, acetylsalicylic acid, diclofenac, ibuprofen, naproxen sodium, and triptans have the highest level of evidence for the treatment of migraine attacks,” the authors said.
While triptans are widely used to treat acute migraines, they are not appropriate for many people, particularly those with cardiovascular disease (CV). Ditans and gepants, two orally given small-molecule medicines, have been licensed by the FDA to treat acute migraine episodes. They are regarded safe and effective for individuals with CV after being evaluated in phase 3 randomized, placebo-controlled studies.
Patients are warned, however, against using dihydroergotamine on a regular basis due to the possibility of adverse events (AEs). Furthermore, the Canadian Headache Society advises against frequent use of combination analgesics including codeine or tramadol, opioids, and butalbital-containing drugs, and recommends screening at-risk individuals for medication misuse.
“Older medications remain effective, although newer medications may be preferred for certain groups of patients,” the article’s authors stated.
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