Migraine Headaches

Migraine– Severe, throbbing, vascular headache

– Recurrent unilateral head pain– Combined with neurologic and GI

disturbances• 90% of migraine sufferers report nausea.

• Sensitivity to light, sound, and stimulation are also common.

Components of classic migraine (all five not experienced by every migraine sufferer):– Prodrome– Aura– Headache– Headache relief– Postdrome

Migraine Headaches

Serotonin appears to be involved in cause.– Decreased levels = excessive vasodilation in cranial

arteries = headache.– By stimulating serotonin receptors, vasoconstriction

will occur thereby alleviating the migraine.

Migraine Headaches

Causative Factors

• Diet

• Stress

• Depression

• Sleep habits

• Certain medications

• Hormonal fluctuations

• Atmospheric changes

• Environmental irritants

Migraine Headaches

Initial Treatment• Identifying and eliminating triggers

Ex: red wine, caffeine, certain foods, bright lights

• If attacks are still frequent, drug therapy may be indicated

Migraine Headaches

• Prophylactic TherapyAttempts to prevent or reduce recurrence

• Abortive Therapy– Treats acute migraine attacks

– Taken after headache occurs, at first sign of a headache

Migraine Headaches• Prophylactic Therapy– Anticonvulsants– Beta blockers– Calcium channel blockers– Estrogen– NASAIDs– SSRIs– Tricyclic antidepressants

– sSsSimple analgesics– NSAIDs– Ergotamine-containing

medications– Other drugs

Abortive therapy1. Triptans—Selective 5-HT Receptor Agonists– almotriptan –eletriptan – frovatriptan –naratriptan – rizatriptan – sumatriptan – zolmitriptan

Sumatriptan •Binds to serotonin receptors causing

vasoconstriction of blood vessels in the dura•Use at first sign of headache

•Available in injection, nasal spray, and tabletRizatriptan

•Sublingual tablet, quickly absorbed•Has most rapid onset of action of all oral

migraine therapies

2. Ergot Preparations (vasoconstictors, but can induce vomiting)

• dihydroergotamine • ergotamine

• ergotamine-caffeine (Cafergot)3. Antiemetic Agents e.g. metoclopramide

• Reduces nausea and vomiting• Enhances absorption of other antimigraine products• Metoclopramide and aspirin have been prescribed

together instead of using sumatriptan

4. Opiod Analgesic• Butorphanol, tramadol • Butorphanol

– Nasal spray is used more commonly than injection– Has analgesic properties for moderate-to-severe pain

– Can be addictive and is abused• Tramadol

– High success rate when given with NSAIDs (ibuprofen)– Has slow onset of action

– Is not a controlled substance, but has shown potential for addiction

5. Beta Blocker• propranolol

Drug combination

• Combination of analgesic, sedative, and vasoconstrictor may be used.

• Has fewer side effects than ergotamines, but may be less effective.