Drug Therapy for Migraine

Migraine significantly disturbs the quality of life of the patients by causing severe throbbing headache associated with neurological, autonomic, and gastrointestinal symptoms. Management of migraine starts from the correct diagnosis based on the classification proposed by the International Headache Society in 2004. Treatment failure and medication overuse and abuse commonly result from misdiagnosis of specific type of headache. Treatment includes: (1) nonpharmacological therapy (patient education, regular exercise, abstinence of caffeine and alcohol drinking, avoidance of fasting, and regular sleep), (2) acute pharmacological therapy (simple analgesics, NSAIDs, ergotamines, triptans, etc.), and (3) prophylactic pharmacological therapy (beta- blockers, calcium channel blockers, antidepressants, and anticonvulsants). Because individual drugs have their unique properties and drug interactions, careful selection and combination of the drugs must be made on the basis of the patient's migraine type, associated symptoms, and comorbidities. One of the complications of migraine drug therapy is transformation of episodic migraine into chronic daily headache that is caused by abuse or overuse of anti-migraine drugs. So the correct diagnosis of migraine and appropriate pharmacological and non-pharmacological treatments are of utmost importance in improving the patient's quality of life and prevention of medication-overuse headache.

Perception of Non-pharmacological Therapy for Pain Control and Pattern of Postoperative Pain in Gynecological Surgery Patients / 여성건강간호학회지

PURPOSE: Women who undergo gynecological surgery have moderate and severe sensation and distress of pain despite the advent of patient controlled analgesia (PCA). The purposes of this study were to describe perception of non-pharmacological therapy for postoperative pain control and examine changes of pain sensation and distress in women who had gynecological surgery. METHOD: The sample consisted of 52 women who were having gynecological surgery. Subjects who agreed to participate in the study were asked for their opinion about non-pharmacological approaches for postoperative pain control using a structured study questionnaire. Pain sensation and distress were assessed by VAS in the morning and afternoon for 2 days following the surgery. RESULT: About 50% of the subjects thought that non-pharmacological methods such as relaxation, music, massage, or meditation would be helpful for their postoperative pain control. If both pharmacological and non-pharmacological therapy were given for pain control, 96% of subjects reported it would be effective. Nurses can apply techniques of relaxation, deep breathing, meditation, and music therapy to surgical patients along with PCA. Expected sensation and distress of pain was high, but pain levels gradually decreased over time. However, subjects experienced moderate levels of pain postoperatively although they used PCA. CONCLUSION: The effect of a combined method of pharmacological and non-pharmacological approach needs to be tested if postoperative pain is to be decreased more.