Migraine Headaches:
A Pharmacotherapy Update By: Dr. Kaitlyn Gibson Introduction
Migraine is a neurological disorder that results in headache attacks characterized by moderate to severe pain. These headaches have a complex pathophysiology with involvement of various neural networks. The pain from an attack is thought to be caused by activation of trigeminal sensory pathways which innervate various intracranial structures, such as the eyes. 1 The typical course of a migraine attack consists of a premonitory phase (in which some individuals may experience aura, which are reversible neurological symptoms), the headache, and a headache resolution phase. Attacks may last anywhere from 4 to 72 hours, during which time many individuals experience disabling symptoms. Among the most common symptoms are
photophobia, phonophobia, and gastrointestinal symptoms such as nausea and vomiting; however, individuals can experience a wide variety of other symptoms unique to their migraine attacks.1 In the 2012 National Health Interview Survey, 14.2% of adults in the United States reported a migraine in the previous 3 months.2 Migraines are most prevalent in the those who are 18- to 44-years, with females being more affected than males (19.1% vs 9.0% over a 3-month period).2 Individuals that experience migraine are significantly impacted both physically and financially. Most patients experience some level of functional disability during an attack due to extreme light, sound, touch, or smell sensitivity, visual disturbances, nausea or vomiting, Page 11
or tingling or numbness in the face or extremities.3 In the International Burden of Migraine Study (IBMS), 79.8% of patients reported severe to very severe disability due to their migraines. The estimated cost over a 3-month period for the treatment of migraine (not including indirect costs) is around $1,000.4 This is a huge financial burden to patients and can include visits to providers or emergency departments, diagnostic testing, and medications.4 In a study published in 2017, 7,671 patients of 857,073 required 2 or more emergency department visits for their migraine and 185,911 saw a neurologist.5 Treatment recommendations vary depending if an individual is being treated for an acute migraine attack or is taking pre-
