Modern strategies for the treatment of migraine attacks and the possibility of a differentiated approach

Abstract

Treatment strategies for migraine  attacks  include the use of nonspecific drugs (simple and combined  analgesics, antiemetics) and specific drugs (triptans, ergotamine derivatives, gepants, ditans), as well as neuromodulation methods. Despite the expansion of the  range  of specific drugs, the  effectiveness of relieving  headache attacks  during migraine  remains  unsatisfactory. The choice of drug for the treatment of migraine attacks is based on their stratification according to the degree  of impairment of the  functional  activity of patients and involves  the  prescription  of specific anti-migraine drugs for moderate and severe disability. The stratified  approach  has a number  of advantages in terms  of the  main parameters of analgesic  effectiveness, is associated with lower treatment costs and carries a lower risk of analgesic  abuse. Migraine attacks are characterized by high polymorphism  and the presence of many clinical manifestations, which largely determine the severity of the patient’s disability and sometimes require  independent treatment. Specific drugs for the treatment of migraine  attacks  (triptans) can relieve not only headaches, but also symptoms of nausea, vomiting, photo- and phonophobia. The choice of drug is based on the individual characteristics of the  patient,  the  profile  of migraine  attacks  and  involves  taking  into  account  the  pharmacological properties of the drug. Features  of migraine  such as a high rate  of increase  in pain during an attack, the presence of rapidly developing nausea, and the need to provide long-term pain relief require the use of fast-acting forms of medications. The benefits of choosing  these  forms are supported by patient  preference studies. Clinical trial data and research  results  from actual clinical practice  allow us to formulate  some approaches to differentiated drug selection.