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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Both the severity and duration of a migraine attack can be reduced significantly by anti-inflammatory agents (Table 15-5). Indeed, many undiagnosed migraineurs are self-treated with nonprescription NSAIDs. A general consensus is that NSAIDs are most effective when taken early in the migraine attack. However, the effectiveness of anti-inflammatory agents in migraine is usually less than optimal in moderate or severe migraine attacks. The combination of acetaminophen, aspirin, and caffeine has been approved for use by the U.S. Food and Drug Administration (FDA) for the treatment of mild to moderate migraine. The combination of aspirin and metoclopramide. | Chapter 015. Headache Part 10 Nonsteroidal Anti-Inflammatory Drugs NSAIDs Both the severity and duration of a migraine attack can be reduced significantly by anti-inflammatory agents Table 15-5 . Indeed many undiagnosed migraineurs are self-treated with nonprescription NSAIDs. A general consensus is that NSAIDs are most effective when taken early in the migraine attack. However the effectiveness of anti-inflammatory agents in migraine is usually less than optimal in moderate or severe migraine attacks. The combination of acetaminophen aspirin and caffeine has been approved for use by the U.S. Food and Drug Administration FDA for the treatment of mild to moderate migraine. The combination of aspirin and metoclopramide has been shown to be equivalent to a single dose of sumatriptan. Important side effects of NSAIDs include dyspepsia and gastrointestinal irritation. 5-HT1 Agonists Oral Stimulation of 5-HTiB id receptors can stop an acute migraine attack. Ergotamine and dihydroergotamine are nonselective receptor agonists while the triptans are selective 5-HTiB iD receptor agonists. A variety of triptans e.g. naratriptan rizatriptan eletriptan sumatriptan zolmitriptan almotriptan frovatriptan are now available for the treatment of migraine. Each drug in the triptan class has similar pharmacologic properties but varies slightly in terms of clinical efficacy. Rizatriptan and eletriptan are the most efficacious of the triptans currently available in the United States. Sumatriptan and zolmitriptan have similar rates of efficacy as well as time to onset whereas naratriptan and frovatriptan are the slowest-acting and least efficacious. Clinical efficacy appears to be related more to the tmax time to peak plasma level than to the potency half-life or bioavailability. This observation is consistent with a large body of data indicating that faster-acting analgesics are more effective than slower-acting agents. Unfortunately monotherapy with a selective oral 5-HTiB iD agonist .
