What Happens to the Old Headache Medicines?


  • Alan M. Rapoport MD

    Corresponding author
    1. From the David Geffen School of Medicine, UCLA, Los Angeles, CA, USA and the New England Center for Headache, Stamford, CT, USA.
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This article is corrected by:

  1. Errata: Erratum Volume 52, Issue 6, 1065, Article first published online: 4 June 2012

  • Conflict of Interest: None.

  • Disclosures: Dr. Alan Mark Rapoport is on the speakers bureau of Allergan, Nautilus Neurosciences, and Zogenix. He is on the advisory board of MAP, Nautilus Neurosciences, NuPathe, and Zogenix, and he is a consultant for Winston.

A.M. Rapoport, The David Geffen School of Medicine at UCLA, 239 South Orange Drive, Suite #27, Los Angeles, CA 90036, USA. email: alanrapoport@gmail.com


Old headache medicines never die; they either fade away or come back in disguise. The disguise is often a new route of administration, which may work better, faster, more completely, with fewer adverse events, and/or have certain other advantages. The clinical aspects of 3 of the oldest headache medicines (ergotamine tartrate, dihydroergotamine, and methysergide) will be discussed here. Sumatriptan will then be discussed as the prototype of the newest category of acute care therapy (triptans) for migraine. It will be compared with the older medications, and the new forms being developed will be briefly discussed. Diclofenac potassium for oral solution will be mentioned as the newest drug approved for migraine by the Food and Drug Administration, and a possible alternative to triptans in patients with frequent headaches or those with contraindications to vasoconstrictors.