Modern guidelines to treat migraine use a stepped or layered approach, according to which the choice of drugs is determined by the severity of disease and response to previous therapy. Thus, patients with migraine of mild/moderate severity should use nonsteroidal anti-inflammatory drugs (NSAIDs) and/or non-opioid analgesics. If a patient has moderate/severe migraine or unsatisfactory response to treatment with NSAIDs and narcotic analgesics, they are recommended the appointment of special preparations to treat migraine or opioid analgesics, although the latter should be used sparingly.
The special drugs for the treatment of migraine, that have a neurovascular action, include ergot derivatives (ergotamine, dihydroergotamine) and triptan. As for the former, they are used in clinical practice today; however, their wide application is hindered by quite a high incidence of side effects due to their low selectivity (primarily nausea and vomiting). In addition, their effectiveness is little studied in controlled clinical trials.
Due to the high pharmacological selectivity and robust evidence base of effectiveness and safety, migraine is usually treated with triptan – selective agonists of serotonin 5-HT1B/1D receptors, which affect all stages of pathogenesis of a migraine attack. One of the representatives of this class is Maxalt which has a number of advantages over other drugs of the class.
Indications for use
Relief of migraine with aura or without it
The ingestion dose is 10 mg. If headache is resumed after relief of the initial attack, the reception of Maxalt may be repeated. The daily dose is 30 mg, the interval between doses is no less than 2 hours. Patients, who receive propranolol, are recommended to apply Maxalt at a dose of 5 mg, the daily dose should not exceed 15 mg.
The effectiveness of re-admission for the relief of the same attack in the absence of effects from the initial dose has not been studied in controlled trials.
Patients with risk of CHD (including, hypertension, diabetes, smoking, a family history of severe coronary artery disease) should carry out a study of the cardiovascular system before starting treatment with the drug. The interval between the reception of Maxalt and ergotamine should be at least 6 hours.
Dizziness, drowsiness, weakness, fatigue, chest pain, abdominal pain, palpitations, nausea, vomiting, dry mouth, diarrhea, dyspepsia, thirst, neck pain, muscle stiffness, feeling of heaviness and stiffness in muscles, muscle weakness, headache, decrease in mental activity, insomnia, hyperesthesia, tremor, ataxia, nervousness, disorientation, skin erythema, pruritus, sweating, blurring of vision, hot flushes; rarely syncope, hypertension
– decompensated hypertension;
— mounted coronary heart disease, including angina, myocardial infarction in anamnesis, documented asymptomatic coronary artery disease;
— suspected ischemic heart disease;
— Prinzmetal’s angina;
— concomitant therapy or less than 2 weeks after the end of treatment with MAO inhibitors;
— hypersensitivity to rizatriptan.
The drug should not be taken by patients with basilar or hemiplegic migraine, atypical migraine headaches, in case of pregnancy, lactation, children’s age.
Interaction with other medications
It should not be used simultaneously with other agonists of serotonin 5-НТ1d receptors. Clinical experience of the use of Maxalt by elderly patients is limited. Maxalt can be applied not earlier than in 2 weeks after the end of treatment with MAO inhibitors. While the use of propranolol, the concentration of rizatriptan in the blood plasma increases.