HCNE - BOSTON Massachussetts General Hospital November 4, 2004 Treatment of Headache ALAN M. RAPOPORT, M.D. Founder and Director The New England Center for Headache Stamford, Connecticut Clinical Professor of Neurology Columbia University College of Physicians & Surgeons New York, N.Y.
17
Embed
HCNE - BOSTON Massachussetts General Hospital November 4, 2004 Treatment of Headache ALAN M. RAPOPORT, M.D. Founder and Director The New England Center.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
HCNE - BOSTON Massachussetts General Hospital
November 4, 2004
Treatment of Headache
ALAN M. RAPOPORT, M.D.Founder and Director
The New England Center for Headache
Stamford, Connecticut
Clinical Professor of Neurology
Columbia University College of Physicians & Surgeons
• Many patients appear to be satisfied with the triptan they are taking
• But is it the ideal triptan for them? It may be. We ask 5 Questions to be sure:
1. How quickly does it start to work?2. When has it reached maximum effect?3. What % of the headache is gone?4. Are there any side effects?5. Does the headache recur within 24 hrs?
So... which is the best triptan?
• The one that works best for YOU!
• The triptans are more similar than different.
PostdromePostdromeProdromeProdrome Headache
Phases of The Migraine AttackWhen to Use Your Triptan
• Frequency– Former: more than two attacks per month– Current: more than two attacks per week
• Disability/QOL related to headache• Unresponsive to acute therapies• Contraindications to acute therapies• Significant adverse events with acute therapies• Pharmacoeconomic considerations
Alternative therapiesAlternative therapies• RiboflavinRiboflavin• MagnesiumMagnesium• ??CyanocobalaminCyanocobalamin• Feverfew, Co Q 10Feverfew, Co Q 10• PetasitesPetasites
Sheftell FD, Rapoport AM, 2004Sheftell FD, Rapoport AM, 2004•Approved indication for migraine in US; †Not available in the US; Approved indication for migraine in US; †Not available in the US; •‡ ‡ Methylergometrine in Europe; NOS = nitric oxide synthase; Methylergometrine in Europe; NOS = nitric oxide synthase; LT = leukotriene; CSD = cortically spreading depressionLT = leukotriene; CSD = cortically spreading depression
Menstrual Migraine - Therapy
• 1. NSAIDs, eg. Naproxen Na 550 mg tid
• 2. COX 2 inhibitor eg. rofecoxib 50 mg qd
• 3. Pulsed estrogens + combo
• 4. Corticosteroids (dexamethasone)
• 5. Short burst of Triptans (all may help)
• 6. Pulsed methylergonovine, beta blockers, ergotamine tartrate, DHE
Perimenstrual Pharmacologic Rx
Conclusion
• Get an accurate diagnosis from MD
• Don’t accept tension-type or sinus headaches as a diagnosis