topiramate and zolmitriptan

To review recent advances in acute and preventive migraine treatment.. The number of migraine drugs continues to expand, allowing for more flexible and tolerable treatment plans. Two new triptans, frovatriptan and eletriptan, and a nasal formulation of zolmitriptan have been recently developed. Eletriptan is effective for acute migraine treatment and may have some pharmacologic and clinical advantages. Frovatriptan has a longer half-life and lower headache recurrence rates compared with other triptans. It may be useful for patients who have prolonged attacks and high headache recurrence rate. Zolmitriptan nasal spray has a rapid onset of action and high efficacy. It should be considered when patients have rapid-onset attacks, especially when associated with severe nausea or vomiting. The butyrophenone neuroleptic droperidol is very effective in aborting acute migraine attacks. Central nervous system side effects are common, however, and the ECG should be monitored. Botulinum toxin type A shows promise as a safe, tolerable and effective drug for migraine prevention, with the unique advantages of almost no systemic adverse events and a long interval between treatments. The anticonvulsant topiramate is effective for migraine prevention. Cognitive side effects are of less concern with the lower doses needed for migraine. The angiotensin converting enzyme receptor blocker candesartan appears to be effective and highly tolerable in the prevention of migraine, but needs to be further evaluated.. New drugs expand the spectrum of migraine treatment both for the acute attack and for prevention.

Topics: Angiotensin Receptor Antagonists; Anticonvulsants; Antipsychotic Agents; Botulinum Toxins, Type A; Carbazoles; Droperidol; Fructose; Humans; Indoles; Migraine Disorders; Neuromuscular Agents; Oxazolidinones; Pyrrolidines; Serotonin Receptor Agonists; Topiramate; Tryptamines

Migraine headaches are common and among the most disabling nonfatal conditions of humankind. They are frequently misdiagnosed, which may lead to undertreatment. Patients often self-diagnose and self-medicate, resulting in inadequate treatment. Consequently, patients may take additional doses, trying to gain relief with inappropriate medications. Rebound can ensue. With adequate treatment, a patient's condition and quality of life may improve considerably. Patient education is extremely important to help patients identify appropriate self-care measures, such as identification of triggering events and coping with the chronic nature of their condition. This case study presents a patient who began experiencing migraines following a neck injury. His headaches became more frequent, and ergotamine and caffeine (Cafergot) suppositories were prescribed. When he presented, he was experiencing daily headaches and using daily ergotamine and caffeine suppositories. He was using the emergency department (ED) frequently because of severe headaches. Cervical spasm was recognized as his trigger, and the ergotamine and caffeine suppositories were discontinued. After 3 days of severe headaches, his rebound ceased. He reverted back to episodic migraines, which he treated with zolmitriptan (Zomig) nasal spray, which was effective. His cervical spasm was treated with botulinum toxin type A (Botox), with excellent results. He has maintained reasonable headache control for 2 years.

Topics: Acupuncture Therapy; Administration, Rectal; Adult; Caffeine; Combined Modality Therapy; Drug Combinations; Ergotamine; Fructose; Humans; Male; Manipulation, Chiropractic; Middle Aged; Migraine Disorders; Neuroprotective Agents; Oxazolidinones; Serotonin Receptor Agonists; Severity of Illness Index; Topiramate; Tryptamines; Vasoconstrictor Agents

Topics: Administration, Intranasal; Botulinum Toxins, Type A; Fructose; Heart Septal Defects, Atrial; Humans; Migraine Disorders; Neuromuscular Agents; Neuroprotective Agents; Oxazolidinones; Serotonin Receptor Agonists; Sleep Bruxism; Topiramate; Tryptamines