The scheme (principles) of the treatment of migraine. When to treat a migraine?

The choice of tactics for the treatment of migraine depends on the frequency and severity of headaches. In patients who do not abuse drugs, but suffer from frequent weak and rare, but severe headaches (for example, with a combination of migraines with tension headaches), prophylactic and emergency treatment may also be effective.

When to treat a migraine?

In general, patients usually notice greater relief from treating low-intensity headaches. For this reason, patients should be advised to start treatment in the early stages of a headache attack, rather than waiting for the development of severe debilitating headaches, drastically reducing work capacity.

Allodynia is an important clinical sign of severe migraine. When a patient develops allodynia in a migraine attack (for example, a feeling of pain in the scalp, pain when wearing glasses or headphones, is more sensitive to touch, pressure, heat or cold), it significantly reduces the effectiveness of pain relief.

For example, the use of sumatriptan in a migraine attack before the onset of symptoms of allodynia is effective in 93% of patients, and with the development of signs of allodynia – only in 15%.

It is noteworthy, but in patients with the rapid development of allodynia in migraine attacks, which cannot be controlled by triptans, intravenous administration of ketorolac is effective. And patients who did not respond to ketorolac therapy had a long-term experience with opioids. Proved that long-term use of opioids activates neurogenic mechanisms that inhibit the action of drugs relieving migraine pain. Based on this information, the following recommendations have been developed:
• triptans should be used at the very beginning of a migraine attack – until clinical signs of allodynia appear;
• symptomatic treatment for developed allodynia, or additional therapy, should include cyclooxygenase-1 or -2 inhibitors, such as ketorolac or indomethacin;
• opioid administration to migraine sufferers should be strictly limited.

local_offerevent_note February 2, 2019

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