Existing and Novel Treatments of Migraine Show Favorable Efficacy

According to a case series published in Cureus highlighting recent developments and trends in pharmacologic treatments for migraine, patients responded to both existing and novel treatments.

In the first of 2 case studies, a 39-year-old Black female patient with a history of reoccurring headaches originally reported headaches that happened a few times a week or a few times a month.

On another visit to the clinic, she reported more frequent headaches at 3 times a week that lasted for about 2 to 4 hours with varying intensity, relapsing, and waning. The headache was accompanied by photophobia, which is eye discomfort in bright light.

The headache started on the left side of her head, extending frontally to behind her eyes, and became throbbing and sharp around her head. She also reported nausea and a few incidents of vomiting after or during the headache. Additionally, she had neck discomfort a few minutes before the headache and may remain throughout the episode, or not at all.

Laying down and not moving her head helped the headache as well as OTC medications, such as acetaminophen or ibuprofen, though sometimes it did not respond to regular medications.

There was no history of trauma, stressors, allergies, and sleeping or psychiatric disorders. There was also no history of migraine and she denied any association with her menses and premenstrual symptoms.

The patient smokes roughly 3 packs per day, was a smoker for more than 18 years, and consumed wine on occasion. She also had obesity with a body mass index of 34.2 kg/m2.

There was no head trauma, and her neck and palpations were normal. The neurological exam was normal as were her physical examinations. The laboratory work was also normal, but the patient’s MIDAS score was 16, indicating moderate disability.

The patient’s magnetic resonance imaging with magnetic resonance venography and magnetic resonance angiography were normal as well as chest X-rays and ECG results. The patient was diagnosed with migraine with aura and was prescribed triptans. She was also prescribed sumatriptan for abortive treatment as well as topiramate for migraine prophylaxis.

She was advised to avoid any triggers and to maintain a headache diary. After 5 months, the patient returned to the clinic and the headache had improved with less than 2 occurrences per month lasting shorter durations.

In case 2, the patient was a 21-year-old female driver with migraine history who reported 3 days of worsening headaches reoccurring for more than 2 years. She described the pain as pounding, which usually started in the temporal region of the head and progressed around the head with occasional pulsations.

She said the headache could occur at any time, but most frequently when she was stressed at work. It was accompanied by flashes of light and inability to look at flashes of light. Before a headache, she reported increased food cravings, mood changes, restlessness, anxiety, and difficulty concentrating. She also experienced numbness in her forearms and vomiting.

The patient reported that noises, movement, position, and light aggravated her headache. She had been advised to take acetaminophen, ibuprofen, and short-acting sumatriptan 50 to 100 mg, 2 hourly as needed during acute attacks.

Her headache did not respond to her usual sumatriptan dosage, and she reported that the headache was more intense, prolonged, and frequent. There was no history of family illnesses, except for her mother, who also suffers from migraine.

Aside from photophobia, the neurological exam was normal as were the patient’s breathing, pulse rate, and blood pressure. The chest exam was normal as well as physical and laboratory exams. Neuroimaging, EKG, and chest X-rays were repeated due to worsening headache, but the imaging was normal.

The patient received intramuscular prochlorperazine 10 mg and IM ketorolac 60 mg, 18 mg dexamethasone, and galcanezumab when her headache subsided. This included the loading dose of 240 mg subcutaneously and 120 mg every month for the following 5 months.

Several months later, the patient reported improvements, but also reported itchiness and rash at the injection sites that went away over time.

Reference

Okobi O E, Boms M G, Ijeh J C, et al. Migraine and current pharmacologic management. Cureus. 2022;14(10):e29833. doi:10.7759/cureus.29833