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West J Med. 1994 September; 161(3): 299–302.
PMCID: PMC1011413



Headache-prone patients have many highly effective therapeutic options open to them. Used only at the time of headache, sumatriptan succinate by mouth or injection and dihydroergotamine nasal spray are novel choices now or soon to be available. The original migraine therapy, ergotamine, is highly effective in its rectal suppository formulation, when used at a subnauseating dosage. Valproate sodium is the latest addition to the many therapies available for long-term stabilization.

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Selected References

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  • Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992 Jun;42(6):1225–1231. [PubMed]
  • Russell MB, Hilden J, Sørensen SA, Olesen J. Familial occurrence of migraine without aura and migraine with aura. Neurology. 1993 Jul;43(7):1369–1373. [PubMed]
  • Silberstein SD. Tension-type and chronic daily headache. Neurology. 1993 Sep;43(9):1644–1649. [PubMed]
  • Raskin NH. Pharmacology of migraine. Prog Drug Res. 1990;34:209–230. [PubMed]
  • Tokola RA, Neuvonen PJ. Effects of migraine attack and metoclopramide on the absorption of tolfenamic acid. Br J Clin Pharmacol. 1984 Jan;17(1):67–75. [PubMed]
  • Perrin VL. Clinical pharmacokinetics of ergotamine in migraine and cluster headache. Clin Pharmacokinet. 1985 Jul-Aug;10(4):334–352. [PubMed]
  • Sanders SW, Haering N, Mosberg H, Jaeger H. Pharmacokinetics of ergotamine in healthy volunteers following oral and rectal dosing. Eur J Clin Pharmacol. 1986;30(3):331–334. [PubMed]
  • Andersen AR, Tfelt-Hansen P, Lassen NA. The effect of ergotamine and dihydroergotamine on cerebral blood flow in man. Stroke. 1987 Jan-Feb;18(1):120–123. [PubMed]
  • de Marées H, Welzel D, de Marées A, Klotz U, Tiedjen KU, Knaup G. Relationship between the venoconstrictor activity of dihydroergotamine and its pharmacokinetics during acute and chronic oral dosing. Eur J Clin Pharmacol. 1986;30(6):685–689. [PubMed]
  • Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology. 1986 Jul;36(7):995–997. [PubMed]
  • Belgrade MJ, Ling LJ, Schleevogt MB, Ettinger MG, Ruiz E. Comparison of single-dose meperidine, butorphanol, and dihydroergotamine in the treatment of vascular headache. Neurology. 1989 Apr;39(4):590–592. [PubMed]
  • Callaham M, Raskin N. A controlled study of dihydroergotamine in the treatment of acute migraine headache. Headache. 1986 Apr;26(4):168–171. [PubMed]
  • Müller-Schweinitzer E. Pharmacological actions of the main metabolites of dihydroergotamine. Eur J Clin Pharmacol. 1984;26(6):699–705. [PubMed]
  • Lane PL, McLellan BA, Baggoley CJ. Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache. Ann Emerg Med. 1989 Apr;18(4):360–365. [PubMed]
  • Jones J, Sklar D, Dougherty J, White W. Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache. JAMA. 1989 Feb 24;261(8):1174–1176. [PubMed]
  • Diamond S, Freitag FG. Do non-steroidal anti-inflammatory agents have a role in the treatment of migraine headaches? Drugs. 1989 Jun;37(6):755–760. [PubMed]
  • Taiwo YO, Levine JD. Prostaglandins inhibit endogenous pain control mechanisms by blocking transmission at spinal noradrenergic synapses. J Neurosci. 1988 Apr;8(4):1346–1349. [PubMed]
  • Willer JC, De Broucker T, Bussel B, Roby-Brami A, Harrewyn JM. Central analgesic effect of ketoprofen in humans: electrophysiological evidence for a supraspinal mechanism in a double-blind and cross-over study. Pain. 1989 Jul;38(1):1–7. [PubMed]
  • Abramson S, Korchak H, Ludewig R, Edelson H, Haines K, Levin RI, Herman R, Rider L, Kimmel S, Weissmann G. Modes of action of aspirin-like drugs. Proc Natl Acad Sci U S A. 1985 Nov;82(21):7227–7231. [PubMed]
  • Carlsson KH, Jurna I. Central analgesic effect of paracetamol manifested by depression of nociceptive activity in thalamic neurones of the rat. Neurosci Lett. 1987 Jun 26;77(3):339–343. [PubMed]
  • Shyu KW, Lin MT, Wu TC. Possible role of central serotoninergic neurons in the development of dental pain and aspirin-induced analgesia in the monkey. Exp Neurol. 1984 Apr;84(1):179–187. [PubMed]
  • Moyer S. Pharmacokinetics of naproxen sodium. Cephalalgia. 1986;6 (Suppl 4):77–80. [PubMed]
  • Banerjee AK. Enteropathy induced by non-steroidal anti-inflammatory drugs. BMJ. 1989 Jun 10;298(6687):1539–1540. [PMC free article] [PubMed]
  • Dechant KL, Clissold SP. Sumatriptan. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the acute treatment of migraine and cluster headache. Drugs. 1992 May;43(5):776–798. [PubMed]
  • Welch KM. Drug therapy of migraine. N Engl J Med. 1993 Nov 11;329(20):1476–1483. [PubMed]
  • Dixon CM, Saynor DA, Andrew PD, Oxford J, Bradbury A, Tarbit MH. Disposition of sumatriptan in laboratory animals and humans. Drug Metab Dispos. 1993 Sep-Oct;21(5):761–769. [PubMed]
  • Bousser MG, D'Allens H, Richard A. Efficacy of subcutaneous sumatriptan in the acute treatment of early-morning migraine: a placebo-controlled trial. Early-Morning Migraine Sumatriptan Study Group. J Intern Med. 1993 Aug;234(2):211–216. [PubMed]
  • Solbach MP, Waymer RS. Treatment of menstruation-associated migraine headache with subcutaneous sumatriptan. Obstet Gynecol. 1993 Nov;82(5):769–772. [PubMed]
  • MacIntyre PD, Bhargava B, Hogg KJ, Gemmill JD, Hillis WS. Effect of subcutaneous sumatriptan, a selective 5HT1 agonist, on the systemic, pulmonary, and coronary circulation. Circulation. 1993 Feb;87(2):401–405. [PubMed]
  • Hillis WS, MacIntyre PD. Sumatriptan and chest pain. Lancet. 1993 Jun 19;341(8860):1564–1565. [PubMed]
  • Diener HC, Dichgans J, Scholz E, Geiselhart S, Gerber WD, Bille A. Analgesic-induced chronic headache: long-term results of withdrawal therapy. J Neurol. 1989 Jan;236(1):9–14. [PubMed]
  • Saper JR, Jones JM. Ergotamine tartrate dependency: features and possible mechanisms. Clin Neuropharmacol. 1986;9(3):244–256. [PubMed]
  • Busto U, Sellers EM, Naranjo CA, Cappell H, Sanchez-Craig M, Sykora K. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med. 1986 Oct 2;315(14):854–859. [PubMed]
  • McArthur JC, Marek K, Pestronk A, McArthur J, Peroutka SJ. Nifedipine in the prophylaxis of classic migraine: a crossover, double-masked, placebo-controlled study of headache frequency and side effects. Neurology. 1989 Feb;39(2 Pt 1):284–286. [PubMed]
  • Spierings EL. Clinical and experimental evidence for a role of calcium entry blockers in the treatment of migraine. Ann N Y Acad Sci. 1988;522:676–689. [PubMed]
  • Sørensen KV. Valproate: a new drug in migraine prophylaxis. Acta Neurol Scand. 1988 Oct;78(4):346–348. [PubMed]
  • Hering R, Kuritzky A. Sodium valproate in the prophylactic treatment of migraine: a double-blind study versus placebo. Cephalalgia. 1992 Apr;12(2):81–84. [PubMed]
  • Diamond S, Kudrow L, Stevens J, Shapiro DB. Long-term study of propranolol in the treatment of migraine. Headache. 1982 Nov;22(6):268–271. [PubMed]
  • Raskin NH, Schwartz RK. Interval therapy of migraine: long-term results. Headache. 1980 Nov;20(6):336–340. [PubMed]

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