Drug safety in acute migraine treatment

Abstract

Introduction: A number of drugs are available for acute migraine treatment, but they are not all effective for all patients and all attacks. The safety profiles of migraine drugs limit their use in patients with certain comorbid conditions, and adverse effects may also reduce the level of patient compliance.

Areas covered: The different types of acute migraine drugs are discussed, with particular regard to safety issues and potential adverse effects. The frequent use of analgesics, ergot alkaloids and triptans may result in the development of medication overuse headache (MOH).

Expert opinion: The initiation of a migraine attack is not fully understood, and therefore treatment aimed at causative factors is currently not available. The tolerability and adverse effects of the drugs available at present often limit their use. NSAIDs are frequently associated with gastrointestinal, and possibly also cardiovascular side effects. Ergot alkaloids may induce arterial vasoconstriction, while the administration of triptans is contraindicated in cardiovascular, cerebrovascular and peripheral vascular diseases. The frequent use of these drugs poses the risk of the development of MOH. There is a need for pathomechanism-based drugs, and for the future achievement of personalized medicine.

Keywords:

• acute treatment
• efficacy
• migraine
• safety
• tolerability

Declaration of interest

This work was supported by the project TÁMOP-4.2.2.A-11/1/KONV-2012-0052, by the Hungarian Brain Research Programme (NAP, Grant No. KTIA_13_NAP-A-III/9.), by EUROHEADPAIN (FP7-Health 2013-Innovation; Grant No. 602633) and by the MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences and the University of Szeged. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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