Nuovi aspetti di terapia nell'emicrania [New aspects of therapy in hemicrania]

Within the pharmacological treatment of migraine it is possible to distinguish treatment of attacks and prevention therapy. The aim of attack treatment is to stop pain and accompanying symptoms, or at least to make them more tolerable, whereas the aim of prophylaxis is to reduce the frequency and possibly the severity and duration of the residual episodes. The choice to initiate either treatment, or both, is based on quantitative criteria, such as attack frequency (if greater than 2-3 per month, prophylaxis treatment is recommendable) and on qualitative features, like the degree of disability, the response and the tolerance of the patient to attack treatment. Prophylaxis treatment has not achieved any improvement since 1981, when propranolol was first utilized. The knowledge of the mechanisms of action of drugs used in prophylaxis, as well as their results, are at a standstill. Even with the newer calcium channel antagonists and beta-blockers we achieve a 50% reduction of attacks in less than half of subjects treated. On the other hand, we had important news in the treatment of migraine attacks. Sumatriptan, a selective agonist of serotonin receptors, represents a therapeutic novelty due both to the results obtained and to the studies that have been stimulated on the pathogenesis of migraine. New therapeutic perspectives are now opening and hopefully thanks to the cooperation of basic and clinical scientists, they might become a reality in a short time