Alvarez de Arcaya Amaya, Eguía del Río Pablo, García-Moncó Juan Carlos*
*Neurology Service. Galdácano Hospital. 48960 Galdácano. Vizcaya
Migraine, randomised controlled trials, headache.
Migraines have become a major socio-health problem as they are a frequent disorder that affects about 12% of the general population and is especially prevalent among young women. An appropriate and individualised handling and treatment may lead to a considerable reduction of the direct and indirect costs deriving from this process.
The basic aims of this paper were to review the pharmacological treatments of migraines that have been studied in controlled clinical trials and that therefore have a basis for being indicated in the treatment of migraines, and to create a number of clinical practice recommendations for treating migraine sufferers in our environment.
Basing ourselves on the work done by the Duke University´s Center for Clinical Health Policy Research (CCHPR), which made a systematic review of controlled clinical trials on the symptomatic and preventive treatment of migraines, published between 1966 and 1996, the survey was extended from 1997 to 2000. After a search made of MEDLINE using the keyword “migraine” and a search strategy of controlled clinical trials (Dickersin et al. 1994), the prospective, controlled and randomised surveys published in English were included, and an appraisal was made of their methodological quality, using the scale conceived by Jadad et al (1996).
During the period 1997-2000, a total of 40 controlled clinical trials in symptomatic treatments of migraines were identified (of these, twelve analysed several migraine attacks) and four relating to preventive treatment. The average primary efficiency used in the majority of surveys which analysed symptomatic treatments was the percentage of patients with a reduction in the intensity from moderate to severe pain to slight to negligible pain. In the case of preventive treatment, the primary efficiency variable was the reduction in the monthly frequency of headaches. Twenty-one trials compared a triptan to a placebo (oral, nasal and subcutaneous sumatriptan; zolmitriptan; oral and sublingual rizatriptan; almotriptan and avitriptan) and another six established comparisons between two triptans (zolmitriptan with sumatriptan and rizatriptan; naratriptan with sumatriptan and rizatriptan and eltriptan with sumatriptan). The remaining surveys on symptomatic treatment focused on the use of painkillers and anti-inflammatory drugs. An assessment was made of the efficiency of sodium valporate, lamotrigine, gabapentine and bisoprolol.
In the different forms these are administered, all the triptans are efficient and well tolerated in the treatment of migraine attacks of a moderate to severe nature. In the case of the presence of nauseas and vomiting, the subcutaneous, nasal or wafer method may be used. Non steroid anti-inflammatory drugs can be considered to be first line medicines for treating slight to moderate intensity migraines. Should the establishment of preventive treatment be considered necessary, beta-blocks would be a first line option, and calcium antagonists or anticomicials such as calcium valproate would be acceptable options.