Treatment of episodic migraine

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 episodic migraine (Japanese Guideline for Chronic Headache 2013).

In acute therapy, we give migraineurs NSAIDs or triptans. We have five triptans (sumatriptan, zolmitriptan, eletriptan, rizatriptan, and naratriptan) in Japan. Notably, sumatriptan 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 injection for a severe attack. It's important to know the best timing to take a triptan just after the attack to get the most effective treatment.

In preventive therapy, we usually use calcium blockers, anti–epileptic drugs, anti–depressants, and β–blockers. Among them, lomerizine, verapamil, valproic acid, amitriptyrine, and propranolol have insurance adaptations in Japan. When we prescribe those drugs, we should choose an appropriate preventive drug with an individual patient. As for the trick of acute treatment, we sometimes give a migraineur both triptan and NSAIDs when a migraineur has a severe attack.