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.