ANS&CNS

Drugs used for migraine

Classical migraine
It is a primary disorder episodic headache disorder characterized by various combinations of neurological, gastrointestinal and autonomic changes

The migraine aura of visual or sensory disturbance probably originates in the occipital or sensory cortex. The throbbing headache is due to dilation of pain sensitive
arteries outside the brain including scalp arteries.

Management of migraine

I- Non-pharmacological
To identify and avoid triggering factors such as
a- Stress
b- Food containing amines (e.g. chocolate, cheese)
c- Bright lights
d- Loud noises
e- Hormonal changes
f- Hypoglycaemia



II- Pharmacotherapy
1- Simple analgesia with antiemetic
Aspirin with antiemetic (domperidone, or metoclopramide)
Paracetamol with antiemetic
Naproxen (NSAID) with antiemetic

II- Pharmacotherapy (continue)

2- selective 5-HT1 agonists (triptans)
They are safe, effective and first line treatment for moderate and sever headache (contraindicated for patients with cardiovascular disorder)
Sumatriptan
It selectively stimulates a subtype 5-HT receptors (5-HT1B/1D) that exist in the cranial blood vessels causing them to constrict

Adverse effects

Generally well tolerated
Malaise, fatigue, dizziness, vertigo and sedation
Nausea and vomiting
Most serious: feeling of chest pain and tightness are due to coronary spasm which is accompanied by cardiac arrhythmia and myocardial infarction
Other drug: zolmitriptan

Ergotamine

No longer the first line because of its adverse effects
Ergots act on serotonergic (5-HT1A, 5-HT2), adrenergic, dopaminergic receptors
peripheral vasoconstriction may persist for as long as 24 hours and repeated doses lead to cumulative effects
Ergotamine may precipitate angina pectoris probably by increasing preload and afterload


Preventive treatment for migraine
Popranolol
Non-selective B-blocker
Pizotifen
Antihistaminic drug with serotonine antagonism
Side effects: sedation, antimuscarinic side effects
Topiramate

Warning

Ergotamine should never be used for prophylaxis of migraine
Ergotamine should not be combined with propranolol. Why?
Repeated doses of ergotamine should be avoided. Why?