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Review Article
Drug Therapy
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Volume 346:257-270 January 24, 2002 Number 4
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Migraine — Current Understanding and Treatment
Peter J. Goadsby, M.D., D.Sc., Richard B. Lipton, M.D., and Michel D. Ferrari, M.D., Ph.D.

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Migraine is a common, chronic, incapacitating neurovascular disorder, characterized by attacks of severe headache, autonomic nervous system dysfunction, and in some patients, an aura involving neurologic symptoms.1,2 Recent advances in basic and applied clinical neuroscience3 have led to the development of a new class of selective serotonin (5-hydroxytryptamine [5-HT]) receptor agonists that activate 5-HT1B and 5-HT1D (5-HT1B/1D) receptors and are known as the triptans; these agents have changed the lives of countless patients with migraine. Despite such progress, migraine remains underdiagnosed and the available therapies underused.4 In this article, we review the current understanding of the epidemiology, pathophysiology, and . . . [Full Text of this Article]

Clinical Manifestations

Pathophysiology

Migraine and the Brain

Pain Mechanisms

Drug Therapy

Preventive Therapy

Treatment of Acute Attacks

Analgesic and Nonsteroidal Antiinflammatory Drugs

Ergot Derivatives

The Triptans

            Pharmacology and Mechanisms of Action

            Safety and Tolerability

Meta-Analysis of Studies of Oral Triptan Therapy

Improvement at Two Hours

Sustained Freedom from Pain

Intrapatient Consistency of Response

Tolerability

Direct Comparisons

Parenteral Sumatriptan

Selecting Initial Treatment for Acute Attacks

The Future of Migraine Treatment


Source Information

From the Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (P.J.G.); the Departments of Neurology, Epidemiology, and Social Medicine, Albert Einstein College of Medicine and the Montefiore Headache Unit, New York (R.B.L.); Innovative Medical Research, Towson, Md. (R.B.L.); and the Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands (M.D.F.).

Address reprint requests to Professor Goadsby at the Institute of Neurology, Queen Sq., London WC1N 3BG, United Kingdom, or at peterg@ion.ucl.ac.uk.

References


Related Letters:

Treatment of Migraine
Werner A., Wyderski R. J., Samuels N., Barker J. N., Ewart R. M., Klein A. W., Goadsby P. J., Lipton R. B., Ferrari M. D.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:764-766, Sep 5, 2002. Correspondence

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