Migraine is a common, chronic, incapacitating neurovasculardisorder, characterized by attacks of severe headache, autonomicnervous system dysfunction, and in some patients, an aura involvingneurologic symptoms.1,2 Recent advances in basic and appliedclinical neuroscience3 have led to the development of a newclass of selective serotonin (5-hydroxytryptamine [5-HT]) receptoragonists that activate 5-HT1B and 5-HT1D (5-HT1B/1D) receptorsand are known as the triptans; these agents have changed thelives of countless patients with migraine. Despite such progress,migraine remains underdiagnosed and the available therapiesunderused.4 In this article, we review the current understandingof 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.
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N Engl J Med 2002;
347:764-766, Sep 5, 2002.
Correspondence
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