Current pain and headache reports
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Headache care specialists agree that the introduction of sumatriptan constitutes a major advance in headache therapy, but they differ about whether other triptans offer clinically significant advantages over sumatriptan. This article examines this issue by considering the similarities and differences among triptans.
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Fibromyalgia (FM) is characterized by abnormal pain sensitivity in response to diverse stimuli as well as persistent widespread pain and other symptoms such as fatigue and sleep disturbance. Progress has been made in identifying factors that contribute to the etiopathogenesis of abnormal pain sensitivity, but there is no single model of pathophysiology or treatment of FM that has gained wide acceptance among health care professionals. ⋯ This model posits that interactions of exogenous (e.g., environmental stressors) and endogenous (e.g., neuroendocrine dysfunction) abnormalities in genetically predisposed individuals lead to a final common pathway, i.e., alterations in central nervous system function and neuropeptide production that underlie central sensitization and abnormal pain sensitivity. This model also suggests that efforts to develop and evaluate treatments for FM should focus on interventions with direct or indirect effects on central functions that influence pain sensitivity.
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Curr Pain Headache Rep · Apr 2002
Review Comparative StudyDo over-the-counter medications help the physician manage migraine headache?
The use of over-the-counter-medication in migraine treatment is commonplace. They are often used in addition to physician-prescribed medications and may be used without the full knowledge of the physician. Although considerable evidence suggests their efficacy in migraine treatment, they are rarely used to maximal levels of efficacy and safety. A review of the evidence for these treatments is important for cost effective, well-tolerated, and specific treatment of migraine headache.
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In the United States analgesic-overuse headache is often caused by butalbital-containing analgesics. These agents can cause physical and psychological dependency, and dangerous withdrawal syndromes. ⋯ In the 20 years since analgesic overuse headache was widely recognized, butalbital overuse has remained distressingly common. It is time to ban these agents.
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The triptans have provided a major advance in the treatment of the pain and disability associated with migraine headache. With seven triptans in use or in clinical development, the clinician is faced with the decision of which triptan to prescribe to the patient with migraine. Although the triptans are pharmacologically similar, they each have unique attributes. This article focuses on the pharmacologic differences between triptans with regard to their pharmacokinetics and drug interactions, and provides some helpful tips on how to optimize migraine treatment with the triptans.