Discussion summary: Getting the right medicine to patients

摘要

Good headache care is not achieved solely by the appropriate use of effective drugs but, for most people with troublesome headache, 'getting the right medicine' is an important part of it. Sadly, many fail to receive anything close to the right medicine. In large parts of the world, the right medicine is simply not available. In other parts, the problem is access rather than availability, often with the existence of multiple barriers. Before discussing these issues further, some thought must be given to what is meant by the 'right medicine'. The focus here is on acute therapy and for migraine. This is neither because migraine is the most common or the most disabling headache disorder, nor because acute therapy is all that we have. It is simply that the issues are very well highlighted by a class of drugs, developed for acute migraine therapy, with a rather poor job of 'getting to patients'. Are triptans the 'right medicine'? Tfelt-Hansen found the evidence defective for triptans as first-line therapy for migraine.2 'Compared with NSAIDs, ... triptans were not superior and in several RCTs triptans caused more adverse events than aspirin plus metoclo-pramide.' He concluded that 'guidelines for treatment should be evidence-based ... effervescent aspirin should be the first-line drug for the treatment of migraine attacks.' This view may have widespread support but it is not the end of the story.