Reasons and Management of Headache (Migraine): A Systematic Review

Abstract

Introduction:

Migraine represents a significant burden, often impairing individuals' productivity at work or school and increasing the likelihood of absenteeism. Recent literature has highlighted concerns regarding the excessive consumption of analgesics and specific migraine medications. This review seeks to explore recent advancements in the treatment of migraines with an emphasis on pain management strategies.

Methods:

A comprehensive literature review was conducted in English on PubMed, Cochrane, and EMBASE databases to gather data on the management of chronic migraines. The search criteria encompassed terms related to chronic migraines, epidemiological measures such as the disease's burden, prevalence, and incidence, and broader chronic headache conditions. Inclusion criteria were set for population-based studies in adult subjects that either reported on the prevalence and incidence of chronic migraines or provided data from which these metrics could be derived.

Results:

Out of the pool, 21 studies were deemed relevant for inclusion in this analysis of migraine treatment modalities. This collection comprised 11 randomized controlled trials, 5 retrospective studies, and 4 prospective chart reviews. Investigated treatments spanned a range, including intravenous therapies, various analgesics, dopamine receptor antagonists, valproic acid, propofol, magnesium, bupivacaine, triptan medications, and dihydroergotamine. A common endpoint for these studies was the assessment of pain reduction using a visual analog scale 30 minutes post-treatment. Notably, one investigation revealed that ibuprofen was significantly more effective than both placebo and acetaminophen in alleviating headache symptoms at the 2-hour mark. Another study highlighted acetaminophen's superiority over placebo in diminishing headache severity.

Conclusions:

The findings underscore a diverse application of first-line treatments within healthcare settings for migraine management. However, the prevalent prescription of narcotic pain relievers raises concerns due to their questionable efficacy in migraine relief, potential for adverse reactions, and the risk of medication overuse and dependency.