Beyond Monotherapy: Rational Polytherapy in Migraine
Version of Record online: 21 MAY 2003
Headache: The Journal of Head and Face Pain
Volume 38, Issue 1, pages 18–22, January 1998
How to Cite
Peroutka, S. J. (1998), Beyond Monotherapy: Rational Polytherapy in Migraine. Headache: The Journal of Head and Face Pain, 38: 18–22. doi: 10.1046/j.1526-4610.1998.3801018.x
- Issue online: 21 MAY 2003
- Version of Record online: 21 MAY 2003
- Accepted for publication June 6,1997.
- Cited By
- dopaminergic hypersensitivity;
- low 5-hydroxytriptamine;
The past decade has seen significant advances in both the scientific and clinical understanding of migraine. At present, a considerable body of data indicates that migraine is characterized by at least three major pathophysiological features: dopaminergic hypersensitivity, inflammation, and relatively “low” 5-HT levels. Clinically, blocking dopamine receptors, reducing inflammation, and/or stimulating a subpopulation of 5-HT, receptors are effective monotherapeutic approaches in many migraineurs. However, monotherapeutic approaches to migraine do not provide rapid, consistent, and complete relief in all migraineurs. Therefore, if monotherapy is suboptimal, it follows logically that concurrent therapy (ie, polytherapy) aimed at modulating two or three of the biological systems should be more efficacious than modulating only a single system. The rationale for the combination use of dopamine antagonists, anti-inflammatory agents, and 5-HT1 agonists are described in the present report.