Treatment Coexisting Conditions
ÎTake coexisting conditions into account. Some (comorbid) conditions are more common in persons with migraine (e.g., stroke, myocardial infarction, Raynaud's phenomenon, epilepsy, affective and anxiety disorders). These conditions present both treatment opportunities and limitations.
ÎSelect the best drug to treat each disorder. Therapeutic independence may be required—i.e., avoid picking a less-effective drug in order to treat more than one disorder with a single medication.
ÎEstablish that the treatments being used for migraine are not contraindicated for the coexistent disease.
ÎEstablish that the treatments being used for coexistent conditions do not exacerbate migraine.
ÎBeware of all drug interactions.
ÎDirect special attention to women who are pregnant or want to become pregnant. Preventive medications may have teratogenic effects. If treatment is necessary, select a treatment with the lowest risk of adverse effects to the fetus.
Nonpharmacologic Treatments
ÎMany migraine patients try nonpharmacologic treatment to manage their headaches before they begin drug therapy or concurrently with drug therapy.
Clinical Considerations
Coexisting Factors Anorexia
ÎCaution should be taken in using topiramate in thin or anorexic patients because it may exacerbate weight loss. By contrast, these patients may benefit from valproic acid, divalproex sodium, or a tricyclic antidepressant.
Asthma
ÎPropranolol and other beta-blockers may have adverse effects on patients with asthma.
Bipolar Disorder
ÎA person with coexistent bipolar disorder might benefit from valproic acid, assuming that he or she does not have underlying liver disease, thrombocytopenia, or pancreatitis and is aware of the risk of alopecia and weight gain.
