TREATING MIGRAINE WITH DRUGS: DIHYDROERGOTAMINE
This has a lesser vasoconstrictive effect than ergotamine and is less effective during the acute attack although it is more frequently used as a preventive drug. It became available in 1943 but it is not used as widely in the U.K. as it is in the rest of Europe. The difference in drug usage between countries is of interest and even the way the drug is administered varies widely, depending on ‘national character’. To generalize, the French like suppositories, the Italians prefer injections, and drops are preferred in Poland. It is possible that differences in dietary habit may have an effect on absorption and interaction of medication.Many patients feel that their migraine attack is ‘something from outside’, and that calming down the headache only postpones the development of the full cycle; they feel that prevention of vomiting only prolongs the time during which they feel nauseated and that it is only after they vomit that they start to feel better. If this is true, then treatment may only prolong the suffering. The mechanism of such a reaction could be explained by a long-lasting chemical change lurking in the background which must be allowed to settle naturally, and it is only by careful study that the basis of the cyclical nature of migraine will be understood.Although the most potent treatment for an acute attack may well be ergotamine, this drug can cause problems and, for this reason, an analgesic such as Paracodol together with an anti-emetic, such as Maxolon, is often preferable.The fact that there are many medications used in the prevention of migraine attacks indicates not only that the production of migraine is highly complex with many stages at which intervention is possible, but also that no single drug is much better than the others. No two sufferers are the same and each patient needs to be treated as an individual. It may be necessary to try a variety of drugs in order to find the one that suits him best.
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