The Old, in with (Mostly) the Old
FEATURE STORY Out With the Old, In With (Mostly) the Old Recent changes to the acute migraine guidelines were more subtle than sweeping. BY ZAC HAUGHN, SENIOR ASSOCIATE EDITOR f guidelines serve as a clinician’s GPS to treatment, the treatments, along with the combination of sumatriptan and American Headache Society’s effort to find best practices naproxen.1 These medications join naratriptan, rizatriptan, in acute migraine therapy involve a good deal of looking sumatriptan, and zolmitriptan, which the 2000 guidelines in the rearview mirror found effective. I “I think it reinforced the old guidelines, but just as The dihydroergotamine inhaler joined the dihydroer- importantly it showed that there’s good evidence that gotamine nasal spray from the previous guidelines on the these drugs work,” said Stephen Silberstein, MD, FACP of strength of two Class I studies. Jefferson University Hospitals, and one of the authors of the A Class I study of patients with non-incapacitating update to the 2000 guidelines by the American Academy of migraine raised oral acetaminophen to Level A from Level B. Neurology. “Some of the newer drugs in combination work. The study revealed acetaminophen produced higher two- We have evidence, for example, for the new DHE inhaled hour headache-free rates than placebo. product, for the sumatriptan patch, and for new formula- Based on four Class I studies, researchers also lifted diclof- tions of non-steroidals,” he said. enac to Level A from Level B. The primary outcome of one But, he added, “I think it’s important to realize there’s noth- was two-hour headache intensity using a visual analog scale ing really new.
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