The drug therapy of migraine

Migraine

The most widely accepted classification of the migraine syndrome includes common, classic, complicated and cluster migraines. Migraine variants refer to episodic dysfunctions of an organ or system which either occur in the migraine sufferer, or replace the headache. While migraine appears to be a primary disorder of the cerebral vessels, there is current experimentation into the role of circulating serotin, prostaglandins, platelet abnormalities and estrogen levels. Both nonnarcotic and narcotic treatments are available, and prophylactic measures may be indicated.

Ergotamine absorption and toxicity

Adverse reactions to ergotamine were noted in 16 out of 41 studies in which therapeutic doses of the drug were given to normal, healthy volunteers. In 17 of the studies 0.25 mg ergotamine was given by injection, 6 i.v. and 11 i.m., in 20 studies 2 mg ergotamine was given by mouth, and 4 subjects received 2 mg ergotamine by suppository. Plasma and urinary ergotamine was measured by radio-immunoassay. Adverse reactions were significantly more frequent in subjects in whom plasma ergotamine exceeded 1.8 ng/ml. Pharmacokinetic data derived from the study are presented and their relevance to the therapeutic use of ergotamine are discussed.

Absorption of effervescent aspirin during migraine

The absorption of effervescent aspirin was studied in 42 patients during acute attacks of migraine. When compared with normal controls and with themselves between attacks 19 out of the 42 patients showed impairment of absorption. Impairment of absorption seemed to correlate with the severity of the headache and the gastro-intestinal symptoms at the time of treatment but not with the duration of the attack or with the type of migraine. This study probably underestimated the prevalence of impairment of absorption in migraine attacks, and it is concluded that the treatment of acute migraine symptoms by oral drugs should use those formulations which are rapidly absorbed under normal conditions.

Buccal absorption of ergotamine

The rate of disappearance of ergotamine from the mouth after buccal administration has been studied in seven subjects. Allowance has been made for non-absorptive losses of the drug due to experimental technique. The absorption of ergotamine across the buccal mucosa appears to be a passive process, pH-dependent but independent of ergotamine concentration or the simultaneous presence of caffeine. Because of the low solubility of ergotamine at the pH of saliva, it is unlikely that therapeutically useful amounts of the drug would have absorbed across the buccal mucosa even after the drug had been in the mouth for five minutes.