Migraine

photo of woman with migraine

Migraine is an important public health problem that affects approximately 12% of adults, with a three-times higher prevalence in women as in men.[1-3] It is among the leading causes of outpatient and emergency department visits.[4] In a recent web-based survey, the average cost of headache among people with episodic migraine was over $2500 per year.[5] More than half of migraine sufferers report a reduction in work, school, and/or household productivity.[3]

It is a chronic, debilitating condition with recurrent episodic attacks. Its characteristics vary among patients and may include throbbing pulsating pain, light sensitivity (photophobia), sound sensitivity (phonophobia), nausea and vomiting, vision changes, and aura. Migraine may also be associated with delayed emptying of the stomach (gastroparesis), which may be one cause of nausea and may also impact the effectiveness (absorption) of orally administered agents used to treat migraine.[6-10]

Triptans are the recommended treatment option for moderate to severe migraine.[11, 12] With a faster onset of action than tablets, non-oral triptan formulations are more likely to provide symptom relief, even when used later in the course of a migraine episode.[13]

 

1. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68(5), 343-349 (2007).

2. Stovner L, Hagen K, Jensen R et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia : an international journal of headache 27(3), 193-210 (2007).

3. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 41(7), 646-657 (2001).

4. Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 55(1), 21-34 (2015).

5. Messali A, Sanderson JC, Blumenfeld AM et al. Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web-Based Survey. Headache 56(2), 306-322 (2016).

6. Aurora SK, Kori SH, Barrodale P, Mcdonald SA, Haseley D. Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack. Headache 46(1), 57-63 (2006).

7. Boyle R, Behan PO, Sutton JA. A correlation between severity of migraine and delayed gastric emptying measured by an epigastric impedance method. British journal of clinical pharmacology 30(3), 405-409 (1990).

8. Tokola RA. The effect of metoclopramide and prochlorperazine on the absorption of effervescent paracetamol in migraine. Cephalalgia : an international journal of headache 8(3), 139-147 (1988).

9. Tokola RA, Neuvonen PJ. Effects of migraine attack and metoclopramide on the absorption of tolfenamic acid. British journal of clinical pharmacology 17(1), 67-75 (1984).

10. Volans GN. Migraine and drug absorption. Clinical pharmacokinetics 3(4), 313-318 (1978).

11. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache 55(1), 3-20 (2015).

12. Gilmore B, Michael M. Treatment of acute migraine headache. American family physician 83(3), 271-280 (2011).

13. Dahlöf CG. Non-oral formulations of triptans and their use in acute migraine. Curr Pain Headache Rep. 2005 Jun;9(3):206-12. Review.