Delivery systems for acute migraine medications.

OBJECTIVE To discuss advantages and disadvantages of various routes of administration and delivery systems for acute migraine medications, and to assist family physicians in optimizing treatment for individual patients.

QUALITY OF EVIDENCE A MEDLINE search from January 1966 to October 2000 and a Current Contents search for the year 1999 to October 2000 were conducted. Randomized controlled trials were selected, when available. Also included are guidelines (Canadian), non-blinded trials, systematic reviews, and population-based studies.

MAIN MESSAGE Selecting an appropriate way to deliver medication is important in acute migraine therapy. The parenteral route has advantages, such as rapid onset, greater efficacy, and the possibility of use during nausea and vomiting. Disadvantages include local site discomfort, inconvenience, and patients' dislike of needles. Most patients prefer oral therapy, but gastric stasis and nausea and vomiting during a migraine attack might limit its use. The intranasal route usually provides fairly rapid onset, but side effects, such as disturbances in taste, can occur. The rectal route is another option, but absorption is sometimes erratic, rectal irritation can occur, and few migraine medications are available in rectal formulation.

CONCLUSION Selection of appropriate medications and suitable delivery systems for individual patients, based on the characteristics of their attacks (e.g., severity, speed of progression to severe intensity, degree of associated symptoms), ease of administration, and patient preference, will optimize therapy for acute migraine attacks.