TREATMENT OF ACUTE ATTACKS ANALGESIC AND NONSTEROIDAL ANTIINFLAMMATORY DRUGS The drug should be taken as soon as the headache component of the attack is recognized. The dose of drug should be adequate; for example, 900 mg of aspirin, 1000 mg of acetaminophen, 500 to 1000 mg of naproxen, 400 to 800 mg of ibuprofen, or appropriate doses of a combination of these drugs.
Antiemetic drugs: Overuse of these drugs should be avoided. Intake should be restricted to no more than two or three days a week, and a headache diary should be kept. As a rule, avoid the use of opiates.
THE TRIPTANS Selective pharmacology, simple and consistent pharmacokinetics, evidence- based prescription instructions, established efficacy based on well- designed controlled trials, moderate side effects, and a well established safety record. The most important disadvantages of the triptans are their higher cost and the restrictions on their use in the presence of cardiovascular disease .
The triptans are serotonin 5- HT-receptor agonists.
Triptans have three potential mechanisms of action: • cranial vasoconstriction, • peripheral neuronal inhibition, • and inhibition of transmission through second-order neurons of the trigeminocervical complex
There are four triptans in routine clinical use: sumatriptan (Imigran®), naratriptan (Naramig®), rizatriptan (Maxalt®), and zolmitriptan (Zomig®).
The oral absorption of many drugs is delayed, so there may be an advantage to non-oral methods of administration, such as the use of nasal sprays, inhalers, suppositories, or injections. Most patients, however, prefer oral formulations.
Tolerability refers to the extent of medically unimportant but clinically irritating side effects of drugs, such as tingling, flushing, and sensations of pressure; safety is assessed on the basis of records of medically important side effects.
The triptans differ from one another in terms of tolerability but not in terms of safety. The most frequent side effects are tingling, parasthesias, and sensations of warmth in the head, neck, chest, and limbs; less frequent are dizziness, flushing, and neck pain or stiffness. It may cause symptoms, closely mimicking angina pectoris.
Sensible contraindications of ischemic heart disease, uncontrolled hypertension, and cerebrovascular disease apply to the entire class.
Meta-analysis, using data from 24 089 patients in 53 controlled clinical trails of triptans, were recently performed.
I. IMPROVEMENT IN TWO HOURS
The headache (pain) response at two hours was the primary end point in nearly all trials of triptans. As compared with 100 mg of sumatriptan, 10 mg of rizatriptan (Maxalt®) and 80 mg of eletriptan were significantly more effective, whereas 2.5 mg of naratriptan, 20 mg of eletriptan, and 2.5 mg of frovatriptan were less effective.
Although the freedom from pain is the currently recommended primary end point, 80 mg of eltriptan, 12.5 mg of almotriptan, and 10 mg of rizatriptan (Maxalt®) were more effective than 100 mg of smatriptan, whereas 25 mg of sumatriptan, 2.5 mg of naratriptan, and 20 mg eleptriptan were less effective than 100 mg of sumatriptan.
- Fall '17