Migraine Headaches by Yl5iX0

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									      Migraine Headaches
Migraine
 – Severe, throbbing, vascular
   headache
 – Recurrent unilateral head pain
 – Combined with neurologic and GI
   disturbances
          Migraine Headaches
• 90% of migraine sufferers report nausea.
• Sensitivity to light, sound, and stimulation are
  also common.
           Migraine Headaches
Components of classic migraine (all five not
experienced by every migraine sufferer):
  –   Prodrome
  –   Aura
  –   Headache
  –   Headache relief
  –   Postdrome
           Migraine Headaches
Prodrome
  Symptom indicating the onset
  Not always present, and varies from individual to
    individual, but can include altered mood,
    irritability, depression or euphoria, fatigue,
    yawning, excessive sleepiness, craving for certain
    food (e.g. chocolate), stiff muscles (especially in
    the neck), hot ears, constipation or diarrhea,
    increased urination, and other visceral symptoms
              Migraine Headaches
Aura
  Subjective sensation or motor phenomenon that
  precedes and marks the onset of a migraine attack
       •   Flashing lights
       •   Shimmering heat waves
       •   Bright lights
       •   Dark holes in visual fields
       •   Blurred or cloudy vision
       •   Transient loss of vision
          Migraine Headaches
Headache and Headache Relief
  Headache generally dissipates in six hours, but may
  last one to two days
           Migraine Headaches
Postdrome
The effects of migraine may persist for some days after
  the main headache has ended; this is called the
  migraine postdrome. Many report a sore feeling in
  the area where the migraine was, and some report
  impaired thinking for a few days after the headache
  has passed. The patient may feel tired or cognitive
  difficulties, gastrointestinal symptoms, mood
  changes, and weakness. According to one summary,
  "Some people feel unusually refreshed or euphoric
  after an attack, whereas others note depression and
  malaise
          Migraine Headaches
Serotonin appears to be involved in cause.
  – Decreased levels = excessive vasodilation in cranial
    arteries = headache.
  – By stimulating serotonin receptors,
    vasoconstriction will occur thereby alleviating the
    migraine.
         Migraine Headaches

Causative Factors
     • Diet           • Hormonal
                        fluctuations
     • Stress
                      • Atmospheric
     • Depression       changes
     • Sleep habits   • Environmental
     • Certain          irritants
       medications
           Migraine Headaches
Initial Treatment
• Identifying and eliminating triggers
  Ex: red wine, caffeine, certain foods, bright lights
• If attacks are still frequent, drug therapy may
  be indicated
          Migraine Headaches
• Prophylactic Therapy
  Attempts to prevent or reduce recurrence
• Abortive Therapy
          Migraine Headaches
• Prophylactic Therapy
  Attempts to prevent or reduce recurrence
• Abortive Therapy
  – Treats acute migraine attacks
  – Taken after headache occurs, at first sign of a
    headache
           Migraine Headaches

• Prophylactic Therapy
  – Anticonvulsants
  – Beta blockers
  – Calcium channel
    blockers
  – Estrogen
  – NASAIDs
  – SSRIs
  – Tricyclic antidepressants
          Abortive therapy
Triptans—Selective 5-HT Receptor Agonists
• almotriptan
• eletriptan
• frovatriptan
• naratriptan
• rizatriptan
• sumatriptan
• zolmitriptan
                sumatriptan
• Binds to serotonin receptors causing
  vasoconstriction of blood vessels in the dura
• Use at first sign of headache
• Available in injection, nasal spray, and tablet
                 rizatriptan
• Sublingual tablet, quickly absorbed
• Has most rapid onset of action of all oral
  migraine therapies
                Abortive therapy

Ergot Preparations (vasoconstictors, but can
  induce vomiting)
• dihydroergotamine
• ergotamine
• ergotamine-caffeine (Cafergot)
              Abortive therapy
Antiemetic Agents
 e.g. metoclopramide
• Reduces nausea and vomiting
• Enhances absorption of other antimigraine
  products
• Metoclopramide and aspirin have been
  prescribed together instead of using
  sumatriptan
              Abortive therapy

Opiod Analgesic
• Butorphanol, tramadol
Beta Blocker
• propranolol
               butorphanol
• Nasal spray is used more commonly than
  injection
• Has analgesic properties for moderate-to-
  severe pain
• Can be addictive and is abused
                 tramadol
• High success rate when given with NSAIDs
  (ibuprofen)
• Has slow onset of action
• Is not a controlled substance, but has shown
  potential for addiction
            Drug combination
• Combination of analgesic, sedative, and
  vasoconstrictor may be used.
• Has fewer side effects than ergotamines, but
  may be less effective.

								
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