Volume : V, Issue : VIII, August - 2015

COMBINATION PROPHYLACTIC PHARMACOTHERAPY IN REFRACTORY MIGRAINE A STUDY

Dr. Ch. Ramakrishna Rao, Dr. W. Maruthi

Abstract :

Introduction. Migraine is the most frequent neurologic disease observed in the clinical practice. This primary headache is associated with an important socioeconomic impact and the World Health Organization recognized the disorder as a major public health problem, by ranking it at 7th place among all worldwide diseases causing ictal disability.Migraine is a paroxysmal disorder with a natural fluctuation between a low and a high frequency pattern in part influenced by modifiable and non–modifiable risk factors. Increased attack frequency can lead to the so–called ‘refractory migraine’, which then becomes less responsive to acute as well as prophylactic migraine medications. Despite substantial advances in migraine therapy, some individuals with migraine are refractory to guidelinebased treatment. However until a well–accepted definition is formulated, evidence–based treatment recommendations for refractory migraine cannot be generated.MaterialsandMethods. In this study, initially, an attempt is made to identify patient populations attending the outpatient department of Neurology, Government General Hospital, Vijayawada between the period of March, 2008 and May, 2015, those may be appropriate to consider for combination preventative therapy. Four classes of drugs are available in the outpatient department and these are β–blockers, (propranolol), calcium channel blockers (flunarazine), antidepressants (amitryptiline) and antiepileptics (sodium valproate). A total of 3,465 subjects were treated for migraine during the period. Out of these, 2874 were women and 591 were men constituting 83% women and 17% men respectively.Results. The results indicate that about 43% of women subjects and about 56% of men subjects are benefited from combination preventive drug therapy for refractory migraine.Discussion. Migraine is a paroxysmal disorder with a natural fluctuation between a low and a high frequency pattern.Till date, there is ample data to suggest that effective acute treatment of migraine is associated with improved responses and decreased disability. But, the potential disease–modifying effects of migraine preventives have not been studied extensively. The success of a physician, or to say, the neurophysician lies in meeting the demands of this subpopulation of the refractory migraineurs. Data guiding duration of preventive therapy are limited. Based on the studies it is suggested that preventative therapy be continued for at least one year.Conclusions. Although it is unknown if migraine preventative therapy confers disease modification, preventive therapy is frequently associated with pain relief and reduction in disability. Limited data and clinical experience suggest that combination therapy should be considered in migraineurs who present with disability and a history of repetitive failed preventive regimens (monotherapies) in the past.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr.Ch.Ramakrishna Rao, Dr.W.Maruthi Combination Prophylactic Pharmacotherapy In Refractory Migraine – A Study Indian Journal of Applied Research, Vol.5, Issue : 8 August 2015

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