Via practica 4/2009

Acute treatment in migraine

The goals of acute treatment in migraine should be sustained pain-free response, which will reduce disability and optimally restore function with minimal adverse events and cost. The strategy for picking the right acute treatment initially should be one of stratified care, matching patient need to migraine characteristics. Disability is a surrogate marker for disease severity, allowing for the decision as to when to use migraine-specific treatment versus nonspecific treatment. The nonspecific treatments (nonsteroidal antiinflammatory drugs; acetylsalicylic acid; etc) can be effective for moderate level migraine with low disability. Triptans represent migraine-specific treatment for severe level migraine with high disability. Triptans are divided into groups by speed of onset and formulation. When possible, patients should be instructed to take triptans early in the migraine attack to make a sustained pain-free response more likely.

Keywords: migraine, acute therapy, stratified care, nonspecific treatment, specific medication/triptans