Current status of migraine treatment―Acute therapy and preventive theraphy

Abstract

Migraine is a chronic, disabling, and recurrent neurological disorder. The guideline published by Japanese Headache Society, based on evidence–based medicine data, is a useful source of guidance, especially for acute and preventive therapies of migraine (Japanese Clinical Practice Guideline for Chronic Headache 2013). At present, migraine therapy can be classed as acute therapy and preventive therapy. In acute therapy, we give migraineurs NSAIDs or triptans for abortive medicines. We have five triptans (sumatriptan, zolmitriptan, eletriptan, rizatriptan, and naratriptan) in Japan. Notably, sumatripotan has three dosage forms (oral tablet, inhalant, and injection). They are used appropriately by the type of migraine attacks. In general, we firstly give an oral tablet. However, when patients have nausea and vomiting, they cannot take oral medicines. At that time, we use inhalant or injection, especially using injection for a severe attack. It's best timing to take a triptan just after the attack to get the most effective treatment. On the other hand, we usually use calcium blockers, anti–epileptic drugs, anti–depressants, and β–blockers for preventive therapy. Among them, lomerizine, verapamil, valproic acid, amitriptyrine, and propranolol have insurance adaptation in Japan. In preventive therapy, you should not change another preventive drug at least two months. Moreover, you should choose appropriate preventive drug with individual patients. As for the trick of acute treatment, we sometimes give a migraineur both triptan and NSAIDs when a migarineur has a severe attack.