[The use of drugs in migraine]

Drugs may be given either for treatment of the acute attack or as prophylaxis. Those most commonly used for the acute attack are analgesics, anti-emetics and ergotamine tartrate. A recent work (Volans, 1974) has shown that absorption may be impaired during a migraine attack. It is important therefore that not only is the analgesic given in an easily absorbed form but that a drug such as metaclopromide should be given to help restore the normal activity of the gastro-intestinal tract. Patients having one or more attacks of migraine a week may need prophylactic treatment. The drugs now used include: Methysergide, should only be used for severe cases when no other treatment has been found helpful. Dihydroergotamine, the vasoconstrictor activity is less than in ergotamine tartrate and can therefore be used prophylactically. Pizotifen, possesses powerful anti-serotonin properties. It also has marked antihistamine and antitryptamine properties as well as being a central sedative and anti-depressant. Clonidine, in doses of 1 mugm/Kg renders the blood vessels less sensitive to circulating amines and seems to be effective in about one third of patients with classical or common migraine. Sympathetic Blocking Agents: alpha-blockers: indoramine has recently given some good results; beta-blockers: such as propanolol and pindolol have also been used. Full trials of all the substances are now in progress. Tranquilisers and anti-depressants, two of those commonly used are diazepam and amitryptiline. In either cases a small dose only should be used. Anticonvulsants, phenytoin in doses of 50-100 mgs per day is sometimes helpful particularly in children or in those who have abnormal electroencephalograms.