Choosing the right drug to treat an attack is a complex task and depends on the intensity and duration of the attack itself, the accompanying symptoms, comorbidities, past experience with drugs, and finally, their cost. Treatment with combination drugs, such as Polygot. This is a combination drug. Ergotamine, a natural ergot alkaloid, increases the tone of dilated extracranial arteries and affects serotonin receptors. Caffeine accelerates and increases absorption of ergotamine.
The main goal of migraine attack treatment is not only elimination of headache and concomitant symptoms, but also quick restoration of patient’s ability to work and improvement of his/her quality of life. Drugs with both nonspecific and specific mechanisms of action are used to treat migraine attacks (abortive therapy). Drugs with a nonspecific mechanism of action are able to reduce the pain syndrome and associated symptoms not only in migraine, but also in other pain syndromes. Drugs with a specific mechanism of action – ergotamine derivatives and triptans are effective only for migraine headaches. Along with this, combined drugs containing both nonspecific analgesics, caffeine, and specific action (ergotamine), as well as antiemetic aids are used.
It should be noted that frequent and prolonged use of analgesics and especially combined drugs leads to addiction and formation of analgesic dependence, which leads to chronic pain syndrome and transformation of migraine into a chronic form. Patients with severe attacks accompanied by nausea and vomiting should not follow the path of gradual selection of drugs at all. Such a treatment will be inherently ineffective, the patient and the doctor will be dissatisfied with the results of treatment, and the search for and constant replacement of the drug will also make the treatment expensive. That is why we propose a stratified approach to treatment selection. According to this approach, the severity of the attack is assessed first, based on an analysis of pain intensity and degree of impairment. In patients with milder attacks it is very likely that medications will be effective. Patients with severe seizures should begin treatment immediately with higher-level medications such as triptans. This will avoid the need for an ambulance in many cases, quickly restore the patient’s ability to work and increase self-control, and reduce feelings of fear and helplessness before another attack. Patients with prolonged severe attacks, migraine status require hospitalization and treatment in a neurological hospital or intensive care unit.
Triptans inhibit the release of vasoactive substances from the peripheral trigeminal nerve endings that cause vasodilation and stimulation of trigeminal nerve endings pain receptors, and also cause contraction of vessels dilated during the attack, which prevents exudation and irritation of pain receptors by algogenic substances that penetrate from blood plasma into the perivascular space.