Migraine Medication /s Or Migraine Treatment

Migraine Medication

 Introduction

Migraine is a type of headache which usually occurs in adolescents or young adults.Headache of migraine occur on one side of the head or in the whole head and 60-80% of migraine headache are familial.Migraine is more common in female than in males.Migraine headache occurs in attacks and each attacks of headache usually last from a few hours to 2 days while the frequency of attacks may varry from one or more attacks in a week to one attack in a year.Migraine is usually precipitated by emotional or physical stress apart from this migraine can also be precipitated by missed meals ,sleep disturbances,menstrual periods,alcohol,foods and oral contraceptives.Severity of Headache varies in different patients it may he throbbing pain or some time it may be dull.migrainenmay also be assoiciated woth vomiting and nausea.it may be preceded or accompanied by certain neurological symptoms such as luminous visual hallucination.Migraine occur due to the involement of trigeminal the perivascular spaces.This perivascular oedema mau cause the stretching of pain receptors in the dural membrane,causing headache of migraine.Also it has been found that sometimes during migraine,amplitude of pulsation of temporal arteries is increased .During aura there is abnormal release of serotinin from the platelets,but during headache of migraine serum serotinin fall below normal.

There is another type of migraine headache which is more common in males than in females which is called Cluster Headache in this type of headahe there is very severe pain around an eye with redness of the eye and watering from the nose and eye .Usually occurs in people age 30 or more and its attack usually occur after every 12-18 months.Attack occur usually at night and each attack last 1-2 hours.They remain for one to three weeks during each cluster.

Classifiacation Of Migriane Drugs / Migraine Medication /s
There are two group of Migraine Medication /s Which are ,

(A) Drugs For the treatment of Acute Attack

(1)5-HT1 Agonist:

Zolmitriptan
Sumatriptan
Rizatriptan
Naratriptan

(2)Other Migraine Medication /s

Ergotamine
Paracetamol
Opioids
Dihydroergotamine
NSAIDs

(B)Prophylactic Drugs

Aspirin
Pizotifine
Propranolol
Amitryptyline
Fluoxetine
Flunarizine
Cyproheptadine
Clonidine
Methylsergide
Sertraline

Ergotamine

Ergotamine is one of the best Migraine Medication and It is an alkaloid obtained from a fungus known as cleviceps purpurea.This Fungus infest the rye and some other grains and grasses.
Pharmacokinetics

It is given orally,sublingually,inhalationaly,by rectal route and by intramuscular injection.When given orally it is absorb from the intestine and its absorption is variable.After metabolism the drugs is excreted in urine.Caffeine increases its absorption from the intestine.

Adverse Effects:

Nausea ,vomiting and diarrhea are the most common adverse effects.
Large doses can cause spasm of the blood vessels of the arms and legs thatmay lead to their gangrene.Rarely gangrene of intestine can occur due to spasm of mesentric artieries.

Contraindications

Perilheral vascular disease such as Reynaud disease and buerger disease.in these disease arteries of the limb are narrowed .
Collagen disease.
Ischemic heart disease
Its better to avoid in pregnant women though there is no evidence of harmful effects.

Triptans

These are a group of drugs that are recently being most commonly used in acute attack of migraine.Their mechanism of action appears to be similar to that of ergot alkaloids.

Sumatriptan

It is a 5HT1B and 5HT1D agonist and it is a great Migraine Medication which is effective in both migraine headache and cluster headache.its effectivenessin these conditions is equal to or more than that of ergot alkaloids.

Pharmacokinetics
When given orally only 15% of sumitriptan is absorbed into the systemic circulation.its plasma half life is two to three hours.it can be used orally,subcutaneously and as a nasal spray.

Adverse effects:
Sumitriptan is well tolerated .it can cause mild degree of abnormal sensation such as dizziness,muscle weakness,tingling,pain in the chest ,pain in the neck and pain at the site of injection.
As it is short acting several doses of drug maybe need during a prolonged attack of migraine.However no more than two doses should be given per day.

Other triptans

Naratriptan

It is also a 5HT1B and 5HT1D agonist.
Use 2.5mg of naratriptan orally after an attack of migraine .
When used orally 40-70% of drug is absorbed from the intestine into systemic circulation.
If migraine recurs then 2.5mg can be used again after 4 hours of intial dose.
If the patient doesn’t respond to the first dose don’t use it again for the same attack.
A maximum of 5mg can be used per day.
Not recommended for patient below 18 year of age.
Plasma half life is about 6 hours
Mechanism and adverse reactions are similar to that of sumitriptan.

Rizatriptan

This drug is also a 5HT1B and 5HT1D agonist and is also a best Migraine Medication .
Mechanism and adverse effect are similar to that of sumatriptan.
when used orally 40-70% absorbed from the small intestine into the systemic circulation.
10mg can be used orally at the onset of an attack and if the migraine recurs then a second dose can be given after 2 hours of the first dose.
Keep that mind if the patient doesn’t respond to first dose then second dose is not used.
Maximum daily dose is 20mg and it is not recommended for children below 18 years.

Almotriptan

Daily recommended Dose is 25 mg.
It is used in a dose of 12.5mg orally as soon as possible after the onset of migraine attack.
For recurrence of migraine a second dose should not be given before 2 hours of the first dose.
If there is no response to the first dose,second dose is not given for the same attack .
It is not recommended in children below 18 years.

Eletriptan

It is used in a dose of 40mg orally as soon as possible after the onset of migraine attack and repeated after 2 hours if recurs.
A second dose is not used if there is no response to the first dose.

Contraindications of triptans

Almotriptan is contraindicated in severe hypertension.

All of 5HT1 Agonist are contraindicated in agina pectoris,because they produce spasm of coronary arteries.

Zolmitriptan is contraindicated in wolf-parkinson-white syndrome.

Sumatriptan,rizatriptan,almotriptan,eletriptan,and zolmitriptan are short acting drugs and therefore several doses of these drugs are required during a prolonged attack.

Noratriptan and almotriptan are contraindicated in severe hepatic and renal diseases and in peripheral vascular diseases.

NSAIDS

All NSAIDs can be used as a Migraine Medications in the treatment of acute attack of migraine.
Opioids may be used in severe cases of migraine not responding to other drugs.As they cause addiction ,care should be taken during their use.

Prophylactic Migraine Medication /s

Following are the important Migraine Medication /s that can be used in the prevention of migraine.

Drugs          Prophylactic Dose
Aspirin        300mg twice daily
Prpranolol   80-240mg/Day in 3-4 doses
Imipramine 10-150mg daily in single dose
Amitriptyline 10-150mg daily in single dose
Fluoxetine    20-60mg in a single dose
Sertraline     50-200mg in a single dose
Clonidine      0.2-0.6mg daily
Mrthylsergide maleate 4-8 mg daily
Verapamil      80-160mg daily
Ergonovine maleate 0.6-2mg daily
Cyprophetadine   12-20mg daily.

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