Patient outcome in migraine prophylaxis: the role of psychopharmacological agents
Maurizio Pompili1,2, Gianluca Serafini1, Marco Innamorati1, Giulia Serra1, Giovanni Dominici1, Juliana Fortes-Lindau1, Monica Pastina1, Ludovica Telesforo1, David Lester3, Paolo Girardi1, Roberto Tatarelli1, Paolo Martelletti4
1Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Italy; 2McLean Hospital – Harvard Medical School, Boston, MA, USA; 3The Richard Stockton College of New Jersey, Pomona, NJ, USA; 4Department of Medical and Molecular Sciences, 2nd School of Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
Introduction: Migraine is a serious illness that needs correct treatment for acute attacks and, in addition, a treatment prophylaxis, since patients with migraine suffer during acute attacks and also between attacks.
Methods: A systematic review of the most relevant clinical trials of migraine headache and its epidemiology, pathophysiology, comorbidity, and prophylactic treatment (medical and nonmedical) was carried out using “Medline” and “PsychINFO” from 1973 to 2009. Approximately 110 trials met our inclusion criteria and were included in the current review.
Results: The most effective pharmacological treatment for migraine prophylaxis is propranolol and anticonvulsants such as topiramate, valproic acid, and amitriptyline. Nonmedical treatments such as acupuncture, biofeedback, and melatonin have also been proposed. Peripheral neurostimulation has been suggested for the treatment of chronic daily headache that does not respond to prophylaxis and for the treatment of drug-resistant primary headache. The majority of the pharmacological agents available today have limited efficacy and may cause adverse effects incompatible with long-term use.
Limitations: The review was limited by the highly variable and often insufficient reporting of the complex outcome data and by the fact that migraine prophylaxis trials typically use headache diaries to monitor the course of the disease. The results of the different studies were also presented in different ways, making comparison of the results difficult.
Discussion: An adequate prophylaxis is crucial in reducing disability and preventing the evolution of the problem into a chronic progressive illness. The implications of the present findings were discussed.
Keywords: migraine, prophylaxis, pharmacological agents, nonmedical treatments, outcome
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