In recent months, there has been an increased focus on the prophylaxis of migraine. Some promising new therapeutic options were presented and also show first positive results. But these treatment strategies are not appropriate for every patient. Therefore, what is the current therapy for acute migraine? Have triptans had their day?
The pathophysiology of migraine has been increasingly deciphered in recent years. Improved characterization and diagnosis of clinical features have led to migraine now being considered a complex, variable disorder of nervous system function rather than just a vascular headache. Recent studies have provided important new insights into the genetic causes, anatomical and physiological features, and pharmacological mechanisms. Identification of new migraine-associated genes, visualization of brain regions activated in the earliest stages of a migraine attack, better assessment of the potential role of cervical nerves, and recognition of the critical role for neuropeptides have led to new targets for migraine therapy. Accordingly, CGRP antibodies were developed for prophylaxis.
Various pharmacologic interventions are available for the acute treatment of migraine. For example, analgesics such as ASA, ibuprofen, or metamizole may be used. Combination preparations of ASA, paracetamol and caffeine also make their contribution to migraine therapy, as confirmed by Prof. Martin Marziniak, MD, Munich (D). However, analgesics are often not sufficient for moderate to severe pain. In this case, a triptan is often resorted to (tab. 1) . These have been developed specifically for the treatment of migraine attacks and are effective in 70% of sufferers and 95% of their attacks. In a way, they mimic the function of the neurotransmitter serotonin in the brain. However, since each preparation attacks at a different point, it definitely makes sense to switch to a different triptan if there is no response, according to the expert. “Three attacks should be treated with the same preparation in the same dosage. If there is insufficient pain relief after that, the dosage can be increased accordingly or the patient can switch to a different preparation,” says Marziniak.
Dosage form can cause rash
Triptans are available as tablets, melting tablets, nasal spray or s.c. injection. Depending on the galenics, pain relief occurs at different rates. Taking it as a tablet is certainly the standard here. But some patients may well prefer a melting tablet. Especially if the sumatriptan is a little slow to take effect. However, it should be kept in mind that recurrent headache may occur, especially with rizatriptan. In these cases, a trial of the nasal spray or s.c injection is worthwhile, the speaker said.
Proven and found to be good
It can be said that triptans have not lost their status as an effective acute medication. On the contrary – for those patients for whom prophylaxis is not an option, they are a valuable contribution to normalizing their quality of life. Although non-drug interventions should not be completely disregarded.
Source: 14th European Headache Federation Congress (EHF)
InFo NEUROLOGY & PSYCHIATRY 2020; 18(5): 33 (published 9/2/20, ahead of print).
