Drug Management of Headache Disorders

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Studies examined new approaches to treatment:

1. Subcutaneous injections of histamine and Botox over 12 weeks both reduced or eliminated migraine headaches in migraine prevention. Although fewer botulinum injections were needed, histamine was less painful and cheaper.

2. Alzheimer’s drug memantine could play a role in migraine prevention, but further investigation is needed.

3. The cholesterol-lowering drug simvastatin used prophylactically in migraine successfully reduced migraine frequency and severity in 11 subjects, but further work is needed to confirm this finding.

4. Adding magnesium salts to existing therapy in migraine sufferers that had failed to respond to preventative treatment reduce headache frequency and severity within a month of treatment, with effects lasting after seven months of treatment.

5. Ayurvedic treatment taken for 90 days gradually reduced the associated symptoms, frequency of attacks and pain intensity in migraine.

Existing therapies were also evaluated. A review of the data on the seven currently available oral triptans used to treat migraine found all provided relief and/or absence of pain at two hours. After 30 minutes, fast-dissolving sumatriptan 50 mg and 100 mg, sumatriptan 50 mg and rizatriptan 10 mg were better than placebo, with fast dissolving sumatriptan 100 mg the only oral triptan superior to placebo at the pain-free end point. Both fast-dissolving sumatriptan strengths and eletriptan 40 mg had a lower migraine recurrence rate, while rizatriptan had a recurrence rate greater than placebo. In considering side effects, both sumatriptan and zolmitriptan had more frequent adverse effects than placebo. Overall, conclude the authors, the data clearly demonstrates the benefits of triptans over placebo.

1. Millan-Guerrero R, Barreto-Vizcaino S, Isais-Millan R et al. Subcutaneous histamine versus botolinum toxin type a in migraine. Abstract F002. 2. Charles A, Brenann KC, Flippen C, Quintanilha A. Memantine for prevention of migraine: a retrospective review of 60 patients. Abstract F063. 3. Kim YJ. Simvastatin in the treatment of migraine. Abstract F086.4. Bermejo P, Escamilla C. Magnesium salts as add-on therapy in refractory migraine. Abstract F131. 5. Prakash V, Babu R, Bhat V et al. Response to Ayurvedic treatment in prevention of migraine: An update of multocentric observational clinical study. Abstract F081. 6. Pascuali J, Jimenez ND, Mateo V. Currently marketed oral triptans: a systemic analysis on the comparative efficacy and tolerability. Abstract F032.

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