Migraine Treatment

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Adjunctive Treatments

Antiemetics

Metoclopramide

Prophylactic/Preventive Therapy

w/ coexisting HTN, tremor

Propranolol

beta-adrenergic blocker

Raynaud's

depression

CHF

AV block

w/ coexisting depression or "fibromyalgia"

Amitriptyline

antidepressant

MOA: Blocks uptake of seratonin

takes 2-3wks for effect!!

asthma

CV disease

urinary retention

glaucoma

dry mouth

weight gain

sedation

w/ coexisting Prinzmetals or Raynaud's

Verapamil

Ca-Channel blocker

Contraindications

heart block

hypotension

constipation

w/ severe refractory migrane

Methysergide

MOA: Serotonin antag.

so it blocks the 1st phase of a migrane

reserved for severe refractory migranes

give pt a drug holiday for 3-4wks q 6mo

dose should be reduced gradually to prevent rebound headaches

Contraindications:

peripheral or cerebral vascular dz

reversable fibrosis

Acute/Abortive Therapy

to eliminate or terminate a HA episode

Triptans

Sumatriptan

high rate of recurrence

Ergot Derivatives

MOA: serotonin agonists

suppress neurogenic inflammation and cause vasoconstriction (2nd phase of migrane)

inhibit release of peptides that cause vasodilation, neuro inflammation, and pain

stimulate 5HT receptors in brain to prevent activation of CN 5

contraindications:

peptic ulcer

angina

HTN

pregnancy

CAD

peripheral vascular dz

if in ER or office setting

Dihydroergotamine

IV, IM, nasal spray

extensive first pass metabolism!!

crosses BBB and binds to dorsal raphe nucleus ("migrane generator") -- the 2nd phase of a migrane

low reccurence rate

N/V

if prescribing for pt. use

Ergotamine

tablet, suppository, IV

overdose:

"Ergotism"

basicaly: cuts off blood supply to extremity

gangrene

periphral vasc insufficiency

vasospasm

extremity parasthesia

diarrhea

epigastic distress

severe N/V

Analgesics

initial line of defense against mild-moderate migraine

effervescent prep more effective d/t rapid absorbtion

contraindications

active ulcer dz

AE:

ulcer

dyspepsia

n/v

Migraine Treatment

The discussed treatments for migraines include both acute and prophylactic therapies. Acute treatments aim to stop a headache episode and involve ergot derivatives, which work by constricting blood vessels and reducing inflammation.

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