Migraine attack treatment : a tailor-made suit, not one size fits all.

About 15% of people in the world suffer migraine attacks. Migraine can induce a great impact in the quality of life, and the costs of medical care and loss of productivity can be also high. Non-steroidal anti-inflammatory drugs (NSAIDs) are the best treatment in mild-to-moderate migraine attacks and triptans are the first line option in the acute treatment of moderate-to-severe migraine attacks. At present, there are seven marketed triptans: sumatriptan, rizatriptan, zolmitriptan, eletriptan, naratriptan, almotriptan and frovatriptan. Obviously, every drug presents different pharmacokinetic and pharmacodynamics properties and, moreover, some triptans have several formulations. The prescription of one of these seven triptans for a specified patient is based in the drug profile: efficacy, safety, pharmacokinetics and pharmacodynamics. Other data to take account in the final prescription are clinical characteristics of the migraine attack (speed of onset, intensity of pain, lasting of the attack) and patient characteristics as working habits, life style or medical history. It is therefore mandatory to perform an individualization of the treatment of migraine attack. In recent years, several new patents of drugs have been registered in the treatment of migraine attack, although most of these are already known drugs that only provide new routes of administration. We present an update on the treatment of the migraine attack.

Are patients referred for presurgical evaluation drug resistant according to the new consensus definition? A study in a tertiary center.

We performed a retrospective chart review of the last consecutive 40 patients admitted in our Epilepsy Unit for presurgical evaluation to find out if they met criteria for drug resistant epilepsy according to the recently published consensus definition. 276 drug trials had been performed in the 40 patients. In total, 196 trials were considered "uninformative" versus 80 informative and adequate trials. Finally, a firm diagnosis of drug resistant epilepsy could be made only in 13/40 patients (32.5%, 90% confidence interval for proportion 21.7-45.5%), due to insufficient information regarding previous drug trials. The definition should be spread among general neurologists for earlier and more complete referrals.