Several medications were recently deemed the most effective for treating acute migraine, including triptans, dihydroergotamine (DHE), nonsteroidal anti-inflammatory drugs (NSAIDS), butorphanol nasal spray, and the combination medication of sumatriptan/naproxen and acetaminophen/aspirin/caffein). Several other migraine medications were considered "probably effective" or "possibly effective."

Q. I had a migraine yesterday morning and took my medication to get rid of it. It got rid of my pounding pain, but about 2 hours later a portion of the right side of my face became numb. Within another 3 hours, the entire right side of my face was numb, my mouth was drooping, and my right arm and leg were heavy. As you can imagine, we thought I could be having a stroke. I am 43. We went to the emergency room, and by the time I arrived, even my speech was affected. All CT scans came back clear. The doctors decided I was having a complex migraine and explained the headaches can present as though the patient is having a stroke. They gave me a migraine "cocktail" and massive steroids and within a half hour, my symptoms were much improved. I am still regaining more control even today. What was so odd was that I had no pain.  Have you heard of this kind of migraine before?

Last month the U.S. Food and Drug Administration (FDA) rejected Levadex ®, an inhaled form of the migraine medication, dihydroergotamine (DHE). This is the second time the agency has failed to approve the medication. DHE has been used in migraine treatment for many years, but it is most effective when given intravenously or via intramuscular injection, requiring a hospital or clinic visit. A DHE nasal spray is also available but is slow to take effect. The inhaled form of the medication is meant to work quickly and can be used at home.

MAP Pharmaceuticals recently announced plans to resubmit its new drug application to the United States Food and Drug Administration (FDA) for Levadex, an inhaled medication meant to treat acute migraine. Company officials recently met with representatives from the FDA and say they hope to resubmit the application in the third or fourth quarters of this year. In March, the FDA sent a Complete Response Letter to the biopharmaceutical company, declining to approve the drug and citing concerns about the drug’s chemistry, manufacturing and controls. Now MAP Pharmaceuticals representatives say those issues have been resolved or will be dealt with as part of the resubmission of the application.

The United States Food and Drug Administration (FDA) declined last month to approve the migraine drug, Levadex ®, an inhaled form of dihydroergotamine (DHE). Approval of the medication is still possible once MAP Pharmaceuticals, the drug's manufacturer, addresses FDA concerns. The company plans to proceed and will meet with FDA officials later this year to address their concerns.

One of the active areas of research for migraine treatment is the development of inhaled methods of getting migraine drugs into the system. These pulmonary inhalers deliver drugs through the airways to the body rapidly and at high concentration. One that is closest to the market is Levadex, which delivers dihydroergotamine (DHE) through what's called the TEMPO® inhaler.

A new generation of headache treatments moving toward the market is based not on new drug formulations, but on making current drugs work faster and more effectively. Numerous presentations given at the International Headache Congress reported positive results regarding new drug delivery systems—from a sumatriptan patch being developed by NuPathe to an inhaled version of dihydroergotamine (DHE) under development by MAP Pharmaceuticals.