Safe Non-opioid and Non-barbiturate containing Acute Medication Combinations in Headache: An Exhaustive Approach Based on DrugBank Database

Structured Abstract Background Rational polypharmacy in abortive medications use is often inevitable for patients with refractory headaches. Objective We seek to enumerate an exhaustive list of headaches abortive medications that are without drug-drug interactions. Methods We updated a list of acute medications based on the widely used Jefferson Headache Manual with novel abortive medications including ubrogepant, lasmiditan, and rimegepant. Opioids and barbiturate containing products are excluded. We then conducted an exhaustive search of all pair-wise interactions for this list of medication via DrugBank API. Using this interaction list, we filtered all possible two, three, and four drug combinations of abortive medications. The resultant list of medication was then reapplied to DrugBank to verify the lack of known drug-drug interaction. Results There are 192 medication combinations that do not contain any drug-drug interactions. Most common elements in these combinations are ubrogepant, prochlorperazine, followed by tizanidine. There are 67 three-drug combinations that do not contain interaction. Only 2 of the four-drug combinations do not yield some form of drug-drug interactions. Conclusion This list of headaches abortive medications without drug-drug interactions is a useful tool for clinicians seeking to more effectively manage refractory headaches.