Active Ingredients: Gabapentin
Side effects and contraindications in combination analgesics are the same as those for each component. Antiemetics Indications Antiemetics are to be considered adjuvants, especially when nausea and vomiting are prominent. Efficacy Most studies have concerned the association of antiemetics with analgesics and NSAIDs naproxen, paracetamol, tolfenamic acid or dihydroergotamine.
These associations have been proposed to improve the absorption of the symptomatic drugs and to act as adjuvants in reducing nausea or vomiting associated with the attacks.
Metoclopramide, prochlorperazine and chlorpromazine have also shown a modest antimigraine effect, besides a clear antiemetic effect. Oral prochlorperazine has also shown some partial efficacy. Dated findings on a limited number of patients support some efficacy of domperidone in preventing migraine attacks or reducing head pain intensity.
Intramuscular or intravenous formulations can be used in the treatment of attacks of severe intensity in which nausea and vomiting are prevailing and in the case in which other symptomatic drugs are contraindicated or sedation is needed.
They can be considered as single drugs for the treatment of migraine in particular clinical settings i. The more frequent adverse events are somnolence and sedation. The occurrence of adverse events due to phenothiazines is facilitated by alcohol or propranolol, which raises their plasma levels.Published in final edited form. Alcohol Clin Exp Res Published online Jan 31.
Contraindications Metoclopramide is contraindicated in patients affected by pheochromocytoma, epilepsy and in combination with neuroleptics such as phenothiazines, butyrophenones, MAOIs. Antiemetics are not recommended in patients with prolactinoma.
The use of metoclopramide, chlorpromazine and prochlorperazine must be limited only to cases of extreme necessity in pregnancy and during breast feeding.
Other drugs Simple or combination opioid analgesics Controlled studies have demonstrated the association of paracetamol with codeine, doxilamine or buclizine to be no more effective than paracetamol alone. The association of ASA with dextropropoxyphen and phenazone was not more effective than ergotamine.
There are no studies comparing butorphanol nasal spray with other non-opioid symptomatic antimigraine drugs. The Ad Hoc Committee has unanimously decided that this class of drugs does not represent a valid option for the symptomatic treatment of migraine attacks.
This is due to the lack of data demonstrating their effectiveness compared with other symptomatic drugs and because of the potential risk of abuse and developing a chronic headache. Other drugs Barbiturates There is no data supporting the efficacy of this class of drugs in the treatment of migraine crises.
Their use should be avoided for the potential risk of abuse, rebound headache and chronification of migraine. Results of randomized, double-blind studies indicate a modest, but significant efficacy although with frequent and early recurrence.
Steroids Available findings are conflicting and do not allow definitive conclusions to be drawn on their effectiveness in the treatment of migraine attacks, particularly in the case of refractory attacks and in reducing headache recurrence.
Steriods are indicated for the treatment of status migrainosus. Limited findings are available for metilprednisolone. One study demonstrated the superiority of the association of dexamethasone and a triptan compared with triptan alone in the treatment of menstrual migraine attacks.