Review of Treatment Strategies for Successful Migraine Management

P ain is the most common reason for consultation with primary care physicians, and the most common pain types evaluated are back pain and headaches.1 Migraine headache is a common complaint, with a higher incidence reported by females. It is estimated that 6% of men and 18% of women currently suffer from this disease.2 However, the prevalence of migraine headache is probably higher, according to the results of the American Migraine Study. Study results indicated that 71% of men and 59% of women were determined to have migraine headaches from self-reported symptoms but they never received a formal diagnosis.3 An accurate estimate of the economic impact of migraine headaches has been difficult to obtain. However, most of the studies attribute the large economic burden to costs associated with disability, decreased functional status, and the consequent indirect costs to employers. A recent study by Stewart al.2 indicated that the average number of migraine attacks per year was 34 for men and 37.4 for women, and 58% of patients needed some bed rest during the attack. Moreover, the study indicated that the annual treatment costs in the U.S. are over one billion health care dollars, 80% of which were spent treating female patients. Physician–office-related expenses accounted for 60% of the total cost and prescription drugs accounted for 30%. Notable is the low cost of emergency department treatment for migraine headache, which accounted for less than 1% of the total cost.3 The indirect cost to American employers was estimated at $13 billion annually. It is important to note that several components that were needed to calculate burden-of-disease estimates were missing from this study, such as the value of lost homeworker tasks; missing work to take care of a family member with a migraine; and decreased involvement in family, social, and leisure activities.4 The aforementioned study and several others indicate that the cost of migraine headache to society is large and comparable to other costly chronic diseases, such as diabetes and asthma.5,6 Several treatment options are now available for migraine headache; however, effective management must incorporate a multidisciplinary approach and remains challenging. Evidence-based multispecialty consensus has been recently developed by the U.S. Headache Consortium in an effort to enhance the care of migraine patients.7 This article will provide an overview of the pharmacological agents used in migraine management, including the recommendations from the U.S. Headache Consortium,7 with a focus on the use and safety of the triptans in the acute management of migraine attacks.