Migraine headache: Rational polytherapy using dopamine antagonists

Objective: The rationale for the concurrent use of dopamine antagonists and other agents in the treatment of migraine are described in the present review. Data Sources: Review of the literature for migraine therapy. Study Selection: MEDLINE search from 1966 through 1996; personal clinical experience. Data Extraction: The studies included were critically evaluated by the author. Data Synthesis: The past decade has seen significant advances in both the scientific and clinical understanding of migraine. At present, a considerable body of data indicates that migraine is characterized by at least three major pathophysiological features: dopaminergic hypersensitivity; inflammation; and relatively "low" 5-HT levels. Clinically, blocking dopamine receptors, reducing inflammation and/or stimulating a subpopulation of 5-HT1 receptors are effective monotherapeutic approaches in many migraineurs. However, monotherapeutic approaches to migraine do not provide rapid, consistent, and complete relief in all migraineurs. Conclusion: If monotherapy is suboptimal in the acute treatment of migraine, it follows logically that concurrent therapy (ie polytherapy) aimed at modulating more than one of the known biological systems involved in migraine should be more efficacious than modulating only a single system.