Migraine

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Migraine Overview
By Dhruv yadav MBBS second proff
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WHAT IS MIGRAINE?
Disorder characterized by episodic attacks of
head pain and associated symptoms, such as
nausea, sensitivity to light, sound, or
intolerance to head movement
Inherited tendency
Neurobiologically based, common clinical problem
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SENSITIVE BRAIN
People with Migraine have altered
neuro-physiologic responses between attacks
Stabbing headache (ice-pick pains)

• Enhanced sensory
• processing
• visual
• auditory

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TRIGGERING MIGRAINE
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THE NEUROVASCULAR THEORY
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THE NEUROVASCULAR THEORY
Migraine is a neurovascular pain syndrome
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CUTANEOUS ALLODYNIA
1-Peripheral Trigeminal Sensitization
3-Forehead Allodynia
4-Thalamic Sensitization
5-Extracephalic Allodynia
2-Central Trigeminal Sensitization
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STRATEGIES FOR MIGRAINE TREATMENT
Preventive treatment Decrease in migraine
frequency warranted
Preemptive treatment Migraine trigger time-limite
d and predictable
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ACUTE MIGRAINE MEDICATIONS

• Nonspecific
• NSAIDs
• Combination analgesics
• Opioids?
• Neuroleptics/antiemetics
• Corticosteroids

• Specific
• Ergotamine/DHE
• Triptans
• CGRP antibodies?

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PREVENTIVE MEDICATIONSDRUG CLASSES
5-HT antagonists
Antidepressants
Neurotoxins

• Other
• Vitamins
• Minerals
• Herbs
• Angiotensin antagonists

?-Blockers
Ca2-Channel blockers
NSAIDs
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d
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HOW DO SPECIFIC MEDICATIONS WORK?
Trigeminovascular Antimigraine Targets
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TRIPTANS

• As a class, relative to nonspecific therapies,
  triptans provide
• Rapid onset of action
• High efficacy
• Favorable side effect profile

Adverse effects. - bradycardia ,coronary
vasospasm
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TRIPTANSTREATMENT CHOICES

• Almotriptan
• Tablet (6.25, 12.5 mg)

• Frovatriptan
• Tablet (2.5 mg)

• Zolmitriptan
• Tablet melt (2.5, 5 mg)
• Nasal spray (5 mg)

• Naratriptan
• Tablet (1, 2.5 mg)

• Are there differences between the triptans?
• If one triptan fails, will another triptan work?

• Rizatriptan
• Tablet melt (5, 10 mg)

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Triptan

• First line drug
• Sumatriptan prototypedrug of this category
• M/A -contriction of arteriovenous shuntof
  carotid artery

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• Inhibit release of inflammatory neuropeptide
• plasma protein extravation
• A/D-Brady cardia ,hypotension,myocardial
  infarction

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• Uses - Acute attack of moderate or severe migraine

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ROUTES OF ADMINISTRATION
Oral therapies most medications
Nasal sprays sumatriptan, DHE, zolmitriptan
Injectable (SL, IM, IV) sumatriptan, DHE,
injectable NSAIDs, neuroleptics
Suppositories antiemetics, ergots, opioids
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GUIDELINES WHEN TO USE PREVENTIVE MANAGEMENT
Acute medications contraindicated, ineffective,
intolerable AEs, or overused
Frequent headache (?3 attacks per month?)
Uncommon migraine conditions
Patient preference
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Calcium channel blocker

• Reduce frequency of migaraine attack
• Act by Blocking cerebroselective calcium
  channel----reduced intracellular
  calcium---reduced migraine attack
• Eg.Flunarizine

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