SYMPTOMATIC AND PROPHYLACTIC TREATMENT OF MIGRAINE - A CRITICAL REAPPRAISAL

The pharmacologic management of migraine has traditionally focused on two approaches: symptomatic treatment and prophylactic therapy. The ob jective of symptomatic treatment is to reduce the intensity and durati on of pain with its attendant symptoms and to optimize the patient's a bility to function normally. The efficacy of most abortive antimigrain ous drugs is probably related to their inhibitory effects on neurogeni c inflammation mediated through serotoninergic control mechanisms. A v ariety of treatment strategies provide effective treatment for most at tacks of moderate to severe migraine when utilizing one or a combinati on of the following classes of drugs: simple analgesics, nonsteroidal anti-inflammatory drugs, antiemetics, narcotic analgesics, ergot deriv atives, and serotonin(1)-agonists. The choice of medication for an acu te attack depends on factors such as the severity of the attack, the p resence or absence of vomiting, time from onset of pain to peak pain l evel, rate of bioavailability of the drug, comorbid medical conditions , and the side effect profile of the drug.The major objective of proph ylactic therapy is the reduction of frequency, duration, and intensity of attacks. Beta-blocking drugs without intrinsic sympathomimetic act ivity (such as propranolol), amitriptyline, flunarizine, serotonin ant agonists (such as methysergide) and nonsteroidal anti-inflammatory dru gs (such as naproxen) are the five main classes of drugs or agents tha t may be used as prophylactics.