Migraine Treatment

Acute/Abortive Therapy

r

to eliminate or terminate a HA episode

Analgesics

r

initial line of defense against mild-moderate migraineeffervescent prep more effective d/t rapid absorbtion

Aspirin

Acetaminophen

Ibuprofen

AE:

n/v

dyspepsia

ulcer

contraindications

active ulcer dz

Ergot Derivatives

r

MOA: serotonin agonistssuppress 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 5

if prescribing for pt. use

Ergotamine

r

tablet, suppository, IV

AE:

severe N/V

epigastic distress

diarrhea

overdose:

"Ergotism"

r

basicaly: cuts off blood supply to extremity

extremity parasthesia

vasospasm

periphral vasc insufficiency

gangrene

if in ER or office setting

Dihydroergotamine

r

IV, IM, nasal sprayextensive first pass metabolism!!crosses BBB and binds to dorsal raphe nucleus ("migrane generator") -- the 2nd phase of a migranelow reccurence rate

AE:

N/V

contraindications:

peripheral vascular dz

CAD

pregnancy

HTN

angina

peptic ulcer

Triptans

Sumatriptan

high rate of recurrence

Prophylactic/Preventive Therapy

w/ severe refractory migrane

Methysergide

r

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 headaches

AE:

reversable fibrosis

Contraindications:

peripheral or cerebral vascular dz

pregnancy

w/ coexisting Prinzmetals or Raynaud's

Verapamil

r

Ca-Channel blocker

AE:

constipation

Contraindications

hypotension

heart block

w/ coexisting depression or "fibromyalgia"

Amitriptyline

r

antidepressantMOA: Blocks uptake of seratonintakes 2-3wks for effect!!

AE:

sedation

weight gain

dry mouth

contraindications

glaucoma

urinary retention

CV disease

asthma

w/ coexisting HTN, tremor

Propranolol

r

beta-adrenergic blocker

AE:

hypotension

AV block

CHF

depression

Raynaud's

Contraindications

asthma

Adjunctive Treatments

Antiemetics

Metoclopramide