Other pharmacological treatments

Treatment guidelines rank the evidence supporting individual ergot alkaloids as ranging from strong to relatively poor. Some guidelines recommend the use of ergot alkaloids in treating migraine, albeit weakly.^{[Marmura et al., 2015; Worthington et al., 2013]}

However, many advise to use newer treatments with higher efficacies and better risk profiles ^{[Steiner et al., 2019]}. The use of opioids for the treatment of migraine is also not agreed on between different treatment guidelines.^{[Vargas, 2018]} The American Headache Society (AHS) ranks one opioid as having established efficacy, but ranks the remaining opioids as ‘possibly effective’ for the treatment of migraine.^{[Marmura et al., 2015]} However, the Canadian Headache Society guidelines for migraine treatment, as well as the European Headache Federation ^{[Steiner et al. 2019]} do not recommend the routine use of opioids in migraine treatment, noting the significant adverse-effect profile associated with opioids, including sedation, dizziness, constipation, tolerance, dependence, and also highlighting their potential for abuse.^{[Worthington et al., 2013]}

References:
Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache 2015; 55 (1): 3–20.

Vargas BB. Acute treatment of migraine. Continuum (Minneap Minn) 2018; 24 (4, headache): 1032–1051.

Worthington I, Pringsheim T, Gawel MJ, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci 2013; 40 (5 Suppl 3): S1–S80.

Other references used on slide:
American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache 2019; 59 (1): 1–18.

DaSilva AF, Nascimento TD, DosSantos MF, Zubieta JK. Migraine and the mu-opioidergic system-Can we directly modulate it? Evidence from neuroimaging studies. Curr Pain Headache Rep 2014; 18 (7): 429.

Diener HC, Jansen JP, Reches A, et al.; Eletriptan and Cafergot Comparative Study Group. Efficacy, tolerability and safety of oral eletriptan and ergotamine plus caffeine (Cafergot) in the acute treatment of migraine: a multicentre, randomised, double-blind, placebo-controlled comparison. Eur Neurol 2002; 47 (2): 99–107.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38 (1): 1–211.

Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition). J Headache Pain 2019; 20: 57.

The Multinational Oral Sumatriptan and Caferget Comparative Study Group. A randomized, double-blind comparison of sumatriptan and cafergot in the acute treatment of migraine. Eur Neurol 1991; 31 (5): 314–322.

Vargas BB. Acute treatment of migraine. Continuum (Minneap Minn) 2018; 24 (4, headache): 1032–1051.