Migraine Treatment
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 migranereserved for severe refractory migranesgive pt a drug holiday for 3-4wks q 6modose should be reduced gradually to prevent rebound headachesContraindications:
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 painstimulate 5HT receptors in brain to prevent activation of CN 5contraindications:
peptic ulcer
angina
HTN
pregnancy
CAD
peripheral vascular dz
if in ER or office setting
Dihydroergotamine
IV, IM, nasal sprayextensive first pass metabolism!!crosses BBB and binds to dorsal raphe nucleus ("migrane generator") -- the 2nd phase of a migranelow reccurence rateN/V
if prescribing for pt. use
Ergotamine
tablet, suppository, IVoverdose:
"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 migraineeffervescent prep more effective d/t rapid absorbtioncontraindications
active ulcer dz
AE:
ulcer
dyspepsia
n/v
Ibuprofen
Acetaminophen
Aspirin
