Migraine Headaches : Acute treatment in Thailand

Main Article Content

Kiratikorn Vongvaivanich, MD


Migraine headache is a very common, chronic neurovascular disorder with a prevalence of 11.7% in the United States of America, and 29.1% in Thailand. Females tend to experience migraine more often than males. The common age group is between 30 and 39 years of age.1, 2 Migraine is characterized by episodes of unilateral, pulsating or throbbing pain which is moderate to severe in its intensity and is often debilitating. It is also associated with nausea, vomiting and hypersensitivity to either light, sound, or smell. Headaches are usually aggravated by routine physical activity and are often alleviated by sleep within appropriate surroundings, such as in a dark, silent and cool place. If untreated or unsuccessfully treated, symptoms can persist from 4 to 72 hours.3 Approximately 90% of the migraineurs have moderate or severe pain. Approximately 75% of cases said their routine functions deteriorated whilst 53% reported serious impairment or required bed rest during attacks.2, 4 At least one half migraineurs complained of decreased productivity and one third missed at least one day of work or school in the previous year.5-7


Download data is not yet available.

Article Details

How to Cite
Vongvaivanich K. Migraine Headaches : Acute treatment in Thailand. BKK Med J [Internet]. 2011Sep.20 [cited 2020Jul.15];2(1):95. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/217774
Continue Medical Education (CME)


1. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007;68:343-9.
2. Phanthumchinda K, Sithi-Amorn C. Prevalence and clinical features of migraine: a community survey in Bangkok, Thailand. Headache 1989;29:594-7.
3. Headache Classification Committee of the International Headache Society, The International Classification of Headache Disorders: 2nd edition, Cephalalgia 2004; 24 (Suppl1):9-160.
4. Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001;41:646-57.
5. Ferrari MD. The economic burden of migraine to society. Pharmacoeconomics 1998;13:667-77.
6. Stewart WF, Lipton RB, Simon D. Work-related disability: results from the American Migraine study. Cephalalgia 1996;16:231-8.
7. Michel P, Dartigues JF, Lindousli A, et al. Loss of productivity and quality of life in migraineurs among French workers: results from the GAZEL cohort. Headache 1997;37:71-8.
8. Bolay H, Reuter U, Dunn AK, et al. Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nat Med 2002;8:136-42.
9. Moskowitz MA. The neurobiology of vascular head pain. Ann Neurol 1984;16:157-68.
10. Nyholt DR, Gillespie NG, Heath AC, et al.Latent class and genetic analysis does not support migraine with aura and migraine without aura as separate entities. Genet Epidemiol 2004;26:231-44.
11. Gervil M, Ulrich V, Kyvik KO, et al. Migraine without aura: a population-based twin study. Ann Neurol 1999;46:606-11.
12. Ulrich V, Gervil M, Kyvik KO, et al. Evidence of a genetic factor in migraine with aura: a populationbased Danish twin study. Ann Neurol 1999;45:242-6.
13. Mochi M, Sangiorgi S, Cortelli P, et al. Testing models for genetic determination in migraine. Cephalalgia 1993; 13:389-94.
14. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell 1996;87:543-52.
15. Dichgans M, Freilinger T, Eckstein G, et al. Mutation in the neuronal voltage-gated sodium channel SCN1A in familial hemiplegic migraine. Lancet 2005;366:371-7.
16. De Fusco M, Marconi R, Silvestri L, et al. Haploinsufficiency of ATP1A2 encoding the Na+/K+ pump alpha 2 subunit associated with familial hemiplegic migraine type 2. Nat Genet 2003;33:192-6.
17. Welch KM. Brain hyperexcitability: the basis for antiepileptic drugs in migraine prevention. Headache 2005; 45(Suppl 1):25-32.
18. Moskowitz MA, Bolay H, Dalkara T. Deciphering migraine mechanisms: clues from familial hemiplegic migraine genotypes. Ann Neurol 2004;55: 276-80.
19. Moskowitz MA, Nozaki K, Kraig RP. Neocortical spreading depression provokes the expression of cfos protein-like immuno-reactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. J Neurosci 1993;13:1167-77.
20. Blau JN. Migraine: theories of pathogenesis. Lancet 1992;339:1202-7.
21. Olesen J, Lipton RB. Migraine classification and diagnosis. International Headache Society criteria. Neurology 1994;44(6 Suppl 4):S6-10.
22. Giffin NJ, Ruggiero L, Lipton RB, et al. Premonitory symptoms in migraine: an electronic diary study. Neurology 2003;60:935-40.
23. Schoonman GG, Evers DJ, Tewindt GM, et al. The prevalence of premonitory symptoms in migraine: a questionnaire study in 461 patients. Cephalalgia 2006; 26:1209-13.
24. Kelman L. The premonitory symptoms(prodrome): a tertiary care study of 893 migraineurs. Headache 2004;44:865-72.
25. Blau JN. Migraine prodromes separated from the aura: complete migraine. Br Med J 1980;281:658-60.
26. Eriksen MK, Thomsen LL, Andersen I, et al. Clinical Characteristics of 362 Patients with Familial Migraine with Aura. Cephalalgia 2004;24:564-75.
27. Kirchmann M. Migraine with aura: new understanding from clinical epidemiologic studies. Current Opinion in Neurology 2006;19:286-93.
28. Jensen K, Tfelt-Hansen P, Lauritzen M, et al. Classic migraine. A prospective recording of symptoms. Acta Neurol Scand 1986;73:359-62.
29. Kelman L. Pain characteristics of the acute migraine attack. Headache 2006;46:942-53.
30. Kelman L. Migraine pain location: a tertiary care study of 1283 migraineurs. Headache 2005;45:1038-47.
31. Selby G, Lance JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 1960;23:23-32.
32. Kelman L. The postdrome of the acute migraine attack. Cephalalgia 2006;26:214-20.
33. Lipton RB, Silberstein SD. The role of headache related disability in migraine management: implications for headache treatment guidelines. Neurology 2001;56 (6 suppl 1):35-42.
34. Lipton RB, Goadsby PJ, Sawyer JPC. Migraine: diagnosis and assessment of disability. Rev Contemp Pharmacother 2000;11:63-73.
35. Lipton RB, Stewart WF, Sawyer J, et al. Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire. Headache 2001;41:854-61.
36. Kosinski M, Bayliss MS, Bjorner JB, et al. A sixitem short-form survey for measuring headache impact: the HIT-6. Qual Life Res 2003;12:963-74.
37. Lipton RB, Stewart WF, Stone AM, et al. Stratified care vs. step care strategies for migraine. The Disability in Strategies of Care (DISC) Study: a randomized trial. JAMA 2000;284:2599-605.
38. Sculpher M, Millson D, Meddis D, et al. Costeffectiveness analysis of stratified versus stepped care strategies for acute treatment of migraine: the Disability in Strategies for Care (DISC) Study. Pharmacoeconomics 2002;20:91-100.
39. Evers S, Afra J, Frese A, et al. European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur J Neurol 2009;16:968-81.
40. Chabriat H, Joire JE, Danchot J, et al. Combined oral lysine acetylsalicylate and Metoclopramide in the acute treatment of migraine: a multicentre double-blind placebo-controlled study. Cephalalgia 1994;14:297-300.
41. Nebe J, Heier M, Diener HC. Low-dose ibuprofen in self-medication of mild to moderate headache: a comparison with acetylsalicylic acid and placebo. Cephalalgia 1995;15:531-5.
42. Tfelt-Hansen P, Henry P, Mulder LJ, et al. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 1995;346:923-6.
43. Suthisisang CC, Poolsup N, Suksomboon N, et al. Metaanalysis of the efficacy and safety of naproxen sodium in the acute treatment of migraine. Headache 2010;50:808-18.
44. Diener HC, Bussone G, de Liano H, et al. Placebo controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks. Cephalalgia 2004;24:947-54.
45. Karachalios GN, Fotiadou A, Chrisikos N, et al. Treatment of acute migraine attack with diclofenac sodium: a doubleblind study. Headache 1992;32:98-100.
46. Lipton RB, Baggish JS, Stewart WF, et al. Efficacy and safety of acetaminophen in the treatment of migraine: results of a randomized, double-blind, placebo-controlled, population-based study. Arch Intern Med 2000;160:3486-92.
47. Lipton RB, Stewart WF, Ryan RE Jr, et al. Efficacy and safety of acetaminophen,aspirin and caffeine in alleviating migraine headache pain: three double-blind, randomized, placebo-controlled trials. Arch Neurol 1998; 55:210-17.
48. Goldstein J, Hoffman HD, Armellino JJ, et al. Treatment of severe, disabling migraine attacks in an over-thecounter population of migraine sufferers: results from three randomized, placebocontrolled studies of the combination of acetaminophen, aspirin, and caffeine. Cephalalgia 1999;19:684-91.
49. Goldstein J, Silberstein SD, Saper JR, et al. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, singledose, placebocontrolled study. Headache 2006;46:444-53.
50. Kudrow D, Thomas HM, Ruoff G, et al. Valdecoxib for treatment of a single, acute, moderate to severe migraine headache. Headache 2005;45:1151-62.
51. Saper J, Dahlof C, So Y, et al. Rofecoxib in the acute treatment of migraine: a randomized controlled clinical trial. Headache 2006;46:264-75.
52. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55:754-62.
53. Friedman BW, Kapoor A, Friedman MS, Hochberg ML, Rowe BH. The relative efficacy of meperidine for the treatment of acute migraine: a meta-analysis of randomized controlled trials. Ann Emerg Med 2008; 52:705-13.
54. Morgenstern LB, Huber JC, Luna-Gonzales H, et al. Headache in the emergency department. Headache 2001;41:537-41.
55. Boureau F, Joubert JM, Lasserre V, et al. Double blind comparison of an acetaminophen 400 mg codeine 25 mg combination versus aspirin 1000 mg and placebo in acute migraine attack. Cephalalgia 1994;14:156-61.
56. Silberstein SD, McCrory DC. Drug treatment of migraine and other headaches. New York: Karger 2000:222-36.
57. Snow V, Weiss K, Wall EM, et al. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med 2002;137: 840-9.
58. Colman I, Brown MD, Innes GD, et al. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. BMJ 2004;329:1369-73.
59. Ellis GL, Delaney J, DeHart DA, et al. The efficacy of metoclopramide in the treatment of migraine headache. Ann Emerg Med 1993;22:191-5.
60. Friedman BW, Corbo J, Lipton RB, et al. A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology 2005; 64:463-8.
61. Matchar DB, McCrory DC, Gray RN. Toward evidence-based management of migraine. JAMA 2000; 284:2640-1.
62. Bigal ME, Bordini CA, Speciali JG. Intravenous chlorpromazine in the emergency department treatment of migraines:A randomised controlled trial. J Emerg Med 2002;23:141-8.
63. Kelly AM, Walcynski T, Gunn B. The relative efficacy of phenothiazines for the treatment of acute migraine: a meta-analysis. Headache 2009;49:1324-32.
64. Tfelt-Hansen P. A review of evidence-based medicine and meta-analytic reviews in migraine. Cephalalgia 2006;26:1265-74.
65. Ferrari MD, Roon KI, Lipton RB, et al. Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001; 358:1668-75.
66. Johnston MM, Rapoport AM. Triptans for the management of migraine. Drugs 2010;70:1505-18.
67. Goadsby PB, Lipton RB, Ferrai MD. Migraine: current understanding and management. N Engl J Med 2002; 346:257-70.
68. Pfaffenrath V, Cunin G, Sjonell G, et al. Efficacy and safety of sumatriptan tablets (25 mg, 50 mg, and 100 mg) in the acute treatment of migraine: defining the optimum doses of oral sumatriptan. Headache 1998;38:184-90.
69. Tepper SJ, Rapoport AM. The triptans: a summary. CNS Drugs 1999;12:403-17.
70. Diamond M, Hettiarachchi J, Hilliard B, et al. Effectiveness of eletriptan in acute migraine: primary care for Excedrin nonresponders. Headache 2004;44: 209-16.
71. Sheftell F, Ryan R, Pitman V, Eletriptan Steering Committee. Efficacy, safety, and tolerability of oral eletriptan for treatment of acute migraine: a multi center, double-blind, placebo-controlled study conducted in the United States. Headache 2003;43:202-13.
72. Silberstein SD, Cady RK, Sheftell FD, et al. Efficacy of eletriptan in migraine related functional impairment: functional and work productivity outcomes. Headache 2007;47:673-82.
73. Winner P, Linder SL, Lipton RB, et al. Eletriptan for the acute treatment of migraine in adolescents: results of a double-blind, placebo-controlled trial. Headache 2007;47:511-8.
74. Cady R, Martin V, Mauskop A, et al. Efficacy of rizat riptan 10 mg. administered early in a migraine attack. Headache 2006;46:914-24.
75. Goadsby PJ, Zanchin G, Geraud G, et al. Early versus non-early intervention in acute migraine- Act when Mild-AwM. A double-blind placebocontrolled trial of almotriptan. Cephalalgia 2008;28:383-91.
76. Tepper SJ, Spears RC. Acute treatment of migraine. Neurol Clin 2009;27:417-27.