The Efficacy and Tolerability of the Use of Combined Versus Single Analgesic and Prophylactic Medications in Severe Migraine
DOI:
https://doi.org/10.35516/jjps.v16i2.1320Keywords:
Excedrin, Diclofenac, Amitriptyline, Propranolol, Pizotifen, Severe migraineAbstract
Background: Migraine is a common cause of primary headaches that may interfere with normal daily activities for which different modalities of treatment had been used. In the present study different types of analgesics and prophylactic medications had been evaluated for their efficacy and tolerability.
Objective: To evaluate the efficacy and tolerability of: 1. Combined analgesic, Excedrin (aspirin with paracetamol and caffeine) in comparison with single analgesic, diclofenac, as a therapy for severe migraine attack.
- Combined prophylactic, amitriptyline, or propranolol with pizotifen in comparison with pizotifen alone as prophylactic drugs for severe migraine.
Materials & Methods: Part (1): 80 patients with severe migraine were enrolled and randomly assigned to receive an oral tablet of either Excedrin (aspirin 250 mg, acetaminophen 250mg, caffeine 65mg) four times daily when needed (n=40) or diclofenac 50mg twice daily when needed as abortive treatment for migraine attack, in addition to the use of pizotifen twice a day in both subgroups for 10 days duration. Part (2): 46 patients who showed good response from part one of the study were divided randomly into three subgroups with different prophylactic regimens.
- oral pizotifen 0.5mg tablet twice a day, n=16.
- oral pizotifen 0.5mg twice a day with propranolol 20mg tablet twice a day, n=15.
- oral pizotifen 0.5mg tablet twice a day with amitriptyline 10mg tablet once at night. n=15.
Efficacy was assessed by determining the patients' number exhibiting improvement with no or mild headache. Tolerability is no or minimal side effects or interactions.
Results: Part (1): A good response to treatment was obtained in 30% of the diclofenac group vs 85% of the Excedrin group (P<0.01). Part (2): A good response to treatment was obtained in 33.3% of the pizotifen group vs 60% of pizotifen with propranolol group (P< 0.05) vs 87.5% of pizotifen with amitriptyline group (P< 0.01).
Conclusion: Combined medications are more effective than single medications in the treatment & prophylaxis of severe migraine.
References
Zargaran, A., Borhani-Haghighi, A., Faridi, P. et al. A review on the management of migraine in the Avicenna’s Canon of Medicine. Neurol Sci 37, 471–478 (2016). https://doi.org/10.1007/s10072-016-2498-9
The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. https://doi.org/10.1177/0333102413485658
Danesh, A., Gottschalk, P.C.H. Beta-Blockers for Migraine Prevention: a Review Article.Curr Treat Options Neurol 21, 20 (2019). https://doi.org/10.1007/s11940-019-0556-3
Sprenger, T., Viana, M. & Tassorelli, C. Current Prophylactic Medications for Migraine and Their Potential Mechanisms of Action. Neurotherapeutics 15, 313–323 (2018). https://doi.org/10.1007/s13311-018-0621-8
Goadsby PJ, Sprenger T. Current practice and future directions in the prevention and acute management of migraine. Lancet Neurol 2010;9(3):285–98.
Jackson JL, Cogbill E, Santana-Davila R, Eldredge C, Collier W, Gradall A, et al. A comparative effectiveness meta-analysis of drugs for the prophylaxis of migraine headache. PLoS One 2015;10(7):e0130733.
Nowaczewska, M.; Wiciński, M.; Kaźmierczak, W. The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment. Nutrients 2020, 12, 2259. https://doi.org/10.3390/nu12082259
Derry S, Moore RA. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008040.
https://doi.org/10.1002/14651858.CD008040.pub3 Accessed 18 August 2021.
Richard B. Lipton MD, Jerome Goldstein MD, Jeffrey S. Baggish MD, Alberto R. Yataco MD, James V. Sorrentino Ph.D., John N. Quiring Ph.D., Aspirin Is Efficacious for the Treatment of Acute Migraine, 05 April 2005, https://doi.org/10.1111/j.1526-4610.2005.05065.x
Sauro, K.M. and Becker, W.J. (2009), The Stress and Migraine Interaction. Headache: The Journal of Head and Face Pain, 49: 1378-1386. https://doi.org/10.1111/j.1526-4610.2009.01486.x
Finocchi, C., Sivori, G. Food as a trigger and aggravating factor of migraine. Neurol Sci 33, 77–80 (2012).
https://doi.org/10.1007/s10072-012-1046-5
Samaneh Hajjarzadeh, Reza Mahdavi, Davood Shalilahmadi & Zeinab Nikniaz (2020) The association of dietary patterns with migraine attack frequency in migrainous women, Nutritional Neuroscience, 23:9, 724-730, https://doi.org/10.1080/1028415X.2018.1550890
Maasumi, K., Tepper, S.J. and Kriegler, J.S. (2017), Menstrual Migraine and Treatment Options: Review. Headache: The Journal of Head and Face Pain, 57: 194-208. https://doi.org/10.1111/head.12978
Derry S, Rabbie R, Moore RA. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008783.
https://doi.org/10.1002/14651858.CD008783.pub3 Accessed 18 August 2021.
Sutherland, H.G. and Griffiths, L.R. (2017), Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders. Headache: The Journal of Head and Face Pain, 57: 537-569. https://doi.org/10.1111/head.13053
Merikangas, K.R. (2012), Update on the Genetics of Migraine. Headache: The Journal of Head and Face Pain, 52: 521-522.
https://doi.org/10.1111/j.1526-4610.2012.02107.x
Carlo Lisotto, Lidia Savi, Lorenzo Pinessi, Mario Guidotti, Stefano Omboni and Giorgio Zanchin, Efficacy of Frovatriptan vs. Other Triptans in Weekend Migraine: Pooled Analysis of Three Double-Blind, Randomized, Crossover, Multicenter Studies, Lisotto, et al., Brain Disord Ther 2014, 3:3 ISSN: 2168-975X https:// https://doi.org/10.4172/2168-975X.1000128
Massiou H, MacGregor EA. Evolution and Treatment of Migraine With Oral Contraceptives. Cephalalgia. 2000; 20(3):170-174.
https://doi.org/10.1046/j.1468-2982.2000.00038.x
Souza WPO, Sousa-Santos PM, Silva-Néto RP. A Historical Review of Headaches: Who First Described Them and When Did This Occur? Headache. 2020 Sep; 60(8):1535-1541. https://doi.org/10.1111/head.13906 . Epub 2020 Aug 7. PMID: 32767765.
Rose FC. The neurology of ancient Greece--an overview. J Hist Neurosci. 1994 Oct;3(4):237-60.
https://doi.org/10.1080/09647049409525617 . PMID: 11618825
Boyer N, Signoret-Genest J, Artola A, Dallel R, Monconduit L. Propranolol treatment prevents chronic central sensitization induced by repeated dural stimulation. Pain 2017;158(10):2025–34.
Baena, Cristina Pellegrino, et al. The effectiveness of aspirin for migraine prophylaxis: a systematic review. Sao Paulo Medical Journal [online]. 2017, v. 135, n. 01 [Accessed 18 August 2021], pp. 42-49. Available from: https://doi.org/10.1590/1516-3180.2016.0165050916 . ISSN 1806-9460.
https://doi.org/10.1590/1516-3180.2016.0165050916
Azize Esra GÜRSOY and Mustafa ERTAŞ, “Prophylactic Treatment of Migraine” Noro Psikiyatr Ars. 2013 Aug; 50(Suppl 1): S30–S35.Published online 2013 Aug 1.
https://doi:10.4274/NPA.y7199
Stephen L. Hauser, Tinsley Randolph Harrison, Scott Andrew Josephson, Joey D. English, John W. Engstrom, Harrison's Neurology in Clinical Medicine, McGraw Hill Professional, 2006, Page 62, 0071457453, 9780071457453
Todd, P.A., Sorkin, E.M. Diclofenac Sodium. Drugs 35, 244–285 (1988).
https://doi.org/10.2165/00003495-198835030-00004
Kirthi, V., Derry, S., Moore, R.A. and McQuay, H.J., 2010. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane database of systematic reviews.
Khalid W. Al-Quliti and Ekhlas S. Assaedi, New advances in the prevention of migraine, Review of current practice and recent advances, Neurosciences Journal July 2016, 21(3) 207-214;
DOI:https://doi.org/10.17712/nsj.2016.3.20150506
Zsolt Hepp, Lisa M. Bloudek, and Sepideh F. Varon, Systematic Review of Migraine Prophylaxis Adherence and Persistence, Journal of Managed Care Pharmacy 2014 20:1, 22-33,
https://www.jmcp.org/action/showCitFormats?doi=10.18553%2Fjmcp.2014.20.1.2
Khalil El-Chammas, MD, Jill Keyes, MD and Jeffrey L Jackson, MD MPH, A comparative effectiveness meta-analysis of drugs for the prophylaxis of pediatric migraine headache, JAMA Pediatr. 2013 March 1; 167(3): 250–258. doi:10.1001/jamapediatrics.2013.508.
Silberstein SD. Preventive Migraine Treatment. Continuum (Minneap Minn). 2015 Aug;21(4 Headache):973-89.
https://doi.org/10.1212/CON.0000000000000199. PMID: 26252585; PMCID: PMC4640499.
Munvar Miya Shaik, Norul Badriah Hassan, Huay Lin Tan, and Siew Hua Gan, Quality of Life and Migraine Disability among Female Migraine Patients in a Tertiary Hospital in Malaysia, BioMed Research International, Volume 2015, Article ID 523717, 9 pages
http://dx.doi.org/10.1155/2015/523717
Goadsby PJ, Sprenger T. Current practice and future directions in the prevention and acute management of migraine. Lancet Neurol 2010;9(3):285–98.
Rao BS, Das D G, Taraknath V R, Sarma Y, A double-blind controlled study of propranolol and cyproheptadine in migraine prophylaxis Neurology India, Year: 2000 | Volume: 48 | Issue Number: 3 | Page: 223-6, https://www.neurologyindia.com/citation.asp?issn=0028
Eman Elayeh, Eman Abu-rish, Al-Moutassem Yousef, Effect of Dividing Low Dose Aspirin on Platelet Reactivity and the Correlation with Patient-related Factors , Jordan Journal of Pharmaceutical Sciences, Volume 13, No. 2, 2020
Safaa Al Awawdeh, Ahmad Naddaf, Abuirmeileh, Amjad,(Errors of Omission in Outpatient Prescriptions in Jordan), Jordan Journal of Pharmaceutical Sciences, Volume 10, No. 3, 2017.
