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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Medical compounds comprised of isometheptene, dichloralphenazone and acetaminophen (Midrin, Amidrin, Migratine) are used to treat vascular headaches or migraines. The combination of isometheptene, a sympathomimetic drug that causes vasoconstriction and dichloralphenazone, a mild sedative, is commonly used during pregnancy. However, no studies of the risk of congenital anomalies are published for either of the two components (isometheptene, dichloralphenazone).
Primary Headache Disorders
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
ETTH can be resolved with nonpharmacologic measures, analgesics, muscle relaxants, or some combination of these modalities. Nonpharmacologic options for TTH include manipulation, massage, exercise, cold or warm packs, stress avoidance, and relaxation techniques (Table 25.2) (Stevens, 1993). When these approaches do not provide adequate relief, simple analgesics, such as acetaminophen (APAP), aspirin (ASA), or nonsteroidal antiinflammatory drugs (NSAIDs), often will relieve the symptoms of ETTH. If simple analgesics fail, caffeinated combination analgesics often will provide effective relief. In TTH studies, it has been shown that it takes about 40% more of a simple analgesic to equal the analgesic potency of the simple analgesic plus caffeine (Laska et al., 1984; Migliardi et al., 1994). If a prescription is required to provide adequate relief, some patients with ETTH will benefit from the combination of isometheptene, APAP, and dichloralphenazone. Other options include the alpha-agonist tizanidine, ASA combined with the muscle relaxants orphenadrine or carisoprodol, or APAP added to chlorzoxazone. In some patients, the symptoms of TTH can be extremely severe and require potentially addictive analgesic combination drugs containing butalbital or an opioid. These drugs provide analgesia and reduce the anxiety often associated with pain (Table 25.3). As with any potentially addicting drug, however, the amount prescribed should be limited and patients should understand that daily or near-daily use must be avoided.
Migraine Medications
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
These medications include Antiemetics Chlorpromazine (IV/IM)Prochlorperazine [IV/IM/per rectum (PR)]Metoclopramide (IV/IM/PR)NSAIDS and nonnarcotic analgesics Ketorolac (IM/IV);Oral NSAIDS: aspirin, naproxen, diclofenac, ibuprofen, etc.—for mild migraineCombination analgesics Aspirin, caffeine—for mild migraineButalbital, aspirin, caffeine (inconsistent in migraine, also used for tension-type headache)Isometheptene mucate, acetaminophen, dichloralphenazoneOpiate analgesics—must be used with great reserve, for acute, severe attacks not responsive to abortive agents Butorphanol INAcetaminophen with codeine, hydrocodone, hydromorphoneOral transmucosal fentanyl citrateNonopiate analgesics TizanidineTramadolMiscellaneous medications Steroids Methylprednisolone dose packDexamethasoneLidocaine IN (better for cluster HA)Valproaic acid (IV)Propfol (IV).
Reductions in acute medication use and healthcare resource utilization in patients with chronic migraine: a secondary analysis of a phase 3, randomized, double-blind, placebo-controlled study of galcanezumab with open-label extension (REGAIN)
Published in Journal of Medical Economics, 2022
Joshua A. Tobin, Shivang Joshi, Janet H. Ford, Russell M. Nichols, Shonda A. Foster, Dustin Ruff, Holland C. Detke, Sheena K. Aurora
Acute medication use for headache was captured in the daily eDiary. The number of migraine headache days per month with acute headache medication use was a prespecified secondary outcome measure based on patients’ eDiary entries. Allowable headache treatments included acetaminophen (paracetamol); nonsteroidal anti-inflammatory drugs (NSAIDs); triptans; ergotamine and derivatives; isometheptene mucate, dichloralphenazone, and acetaminophen combination (Midrin); or combinations thereof. The following medications were allowed with restrictions: (1) opioid and barbiturates no more than 3 days/month and (2) single dose of injectable steroids allowed only once during the study, in an emergency setting. The name and dose of concomitant medications used for the acute treatment of migraine or headache and the use of other pain medications were captured.
Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures: a US societal perspective
Published in Journal of Medical Economics, 2018
Richard B. Lipton, Alan Brennan, Stephen Palmer, Anthony J. Hatswell, Joshua K. Porter, Sandhya Sapra, Guillermo Villa, Neel Shah, Stewart Tepper, David Dodick
The distribution of the drug classes by usage and the dosages used to treat acute migraine were obtained from three studies in the literature35–37. Using acute medication use data collected in the erenumab clinical studies, the model differentiates between migraine-specific acute medication (comprised of triptans and ergot derivatives), and non-migraine-specific acute medication (comprised of acetaminophen, non-steroidal anti-inflammatory drugs [NSAIDs], barbiturates, opioids, isometheptene compounds, and other over-the-counter medications)35. Weighted average costs per day of use are shown in Table 1, and the numbers of days of acute medication use by migraine day frequency are presented in the Supplementary Material.
Predicting initiation of preventive migraine medications: exploratory study in a large U.S. medical claims database
Published in Current Medical Research and Opinion, 2020
Janet H. Ford, Krista Schroeder, Dawn C. Buse, Shivang Joshi, Steven Gelwicks, Shonda A. Foster, Sheena K. Aurora
Logistic regression models were constructed comparing patients that initiated a PMM vs non-PMM initiators (within 1 year of first migraine diagnosis during 2011–2013) as the outcome variable; all variables were measured during the 1-year pre-PMM initiation date period, except where noted. Modified purposeful selection techniques27 were used to build the final multivariate logistic regression models, which used stepwise methods to evaluate predictors for inclusion. Both clinical and theoretical judgment based on the existing literature were applied to select the predictors in the initial model, which at the migraine diagnosis date included gender and at the PMM initiation date included age, geographic region, and plan type (Commercial vs Medicare). Predictors during the 1-year pre-migraine diagnosis date period included headache diagnosis; and predictors during the 1-year pre-PMM initiation date period included number of outpatient visits, ED visits, headache/migraine-specific ED visits (defined as an ED visit with a migraine or headache diagnosis code [346.xx, 307.81, 784.0, 339.1, 339.3] AND 1 of the recommended treatments OR a triptan or opioid)11, neurologist visits, obesity, sleep disorders, cardiovascular disease, allodynia, diabetes mellitus, and consistent acute medication refills (defined as no gap in administrative claims for prescription refills that are received by the patient for any acute medication >90 days in the year pre-index). The acute medication classes included opioids, triptans, barbiturates, isometheptene, and ergots. Nonsteroidal anti-inflammatory drugs were not included due to their common use in both non-migraine pain and migraine disorders, and the inability to capture over-the-counter use.