Migraine: a pharmacologic review with newer options and delivery modalities

The management of migraine usually centers on two approaches: preventive and abortive therapy. Preventive therapy, designed to reduce the frequency, duration, and intensity of attacks, can be accomplished through a wide variety of medications. The most commonly used are beta-blockers, but calcium channel blockers, antidepressants, anticonvulsants, and nonsteroidal anti-inflammatory agents have all been used with success. Agents used in abortive migraine therapy treat the intensity and duration of pain, as well as the associated symptoms. New treatment options have been developed, including such newly approved medications as sumatriptan. Sumatriptan is a very effective agent that has joined the ranks of other effective abortive migraine treatments, such as ergotamine, dihydroergotamine, and nonsteroidal anti-inflammatory agents, as well as narcotic analgesics. New delivery systems, such as the nasal-spray formulation of butorphanol, allow for a route of administration previously unavailable to migraine sufferers. These new and developing treatment modalities will give physicians a wider choice of outpatient therapy options.