Abstract
Background: Migraine is a common cause of primary headaches that may interfere with normal daily activities for which different modalities of treatment had been used. In the present study different types of analgesics and prophylactic medications had been evaluated for their efficacy and tolerability.
 Objective: To evaluate the efficacy and tolerability of: 1. Combined analgesic, Excedrin (aspirin with paracetamol and caffeine) in comparison with single analgesic, diclofenac, as a therapy for severe migraine attack.
 
 Combined prophylactic, amitriptyline, or propranolol with pizotifen in comparison with pizotifen alone as prophylactic drugs for severe migraine.
 
 Materials & Methods: Part (1): 80 patients with severe migraine were enrolled and randomly assigned to receive an oral tablet of either Excedrin (aspirin 250 mg, acetaminophen 250mg, caffeine 65mg) four times daily when needed (n=40) or diclofenac 50mg twice daily when needed as abortive treatment for migraine attack, in addition to the use of pizotifen twice a day in both subgroups for 10 days duration. Part (2): 46 patients who showed good response from part one of the study were divided randomly into three subgroups with different prophylactic regimens.
 
 oral pizotifen 0.5mg tablet twice a day, n=16.
 oral pizotifen 0.5mg twice a day with propranolol 20mg tablet twice a day, n=15.
 oral pizotifen 0.5mg tablet twice a day with amitriptyline 10mg tablet once at night. n=15.
 
 Efficacy was assessed by determining the patients' number exhibiting improvement with no or mild headache. Tolerability is no or minimal side effects or interactions.
 Results: Part (1): A good response to treatment was obtained in 30% of the diclofenac group vs 85% of the Excedrin group (P<0.01). Part (2): A good response to treatment was obtained in 33.3% of the pizotifen group vs 60% of pizotifen with propranolol group (P< 0.05) vs 87.5% of pizotifen with amitriptyline group (P< 0.01).
 Conclusion: Combined medications are more effective than single medications in the treatment & prophylaxis of severe migraine.
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