Strategies to improve migraine treatment results.

摘要

The purpose of this review is to describe strategies for optimizing the use of available agents for acute migraine therapy. Patient satisfaction with migraine therapy depends on obtaining rapid and complete resolution of pain and preventing headache recurrence, making 2-h pain free and sustained pain free more relevant endpoints than 2-h pain relief for assessing acute migraine therapies. Many treatment guidelines recommend a step-care approach to migraine management, that is, starting with a simple analgesic, followed by various combination analgesics, allowing a migraine-specific drug (e.g. a triptan) only after the patient has demonstrated an inadequate response to non-specific treatments. This can result in prolonged morbidity and patients lapsing from care. In the stratified-care approach, the initial treatment is selected according to the individual patient's migraine severity and associated disability, promoting the use of migraine-specific treatments as first-line agents for patients with disabling migraines. Another strategy, triptan treatment during mild headache pain, has been shown to improve treatment success rates compared with treatment delayed until pain is moderate to severe. Treatment before the development of central sensitization is thought to underlie the improvement in outcomes. In conclusion, migraine treatment strategies such as the stratified-care approach and the administration of medication while pain is mild will help increase treatment success rates and substantially reduce patient suffering and disability.