Migraine Headaches

1
(No Transcript)
2
Migraine Headaches

• Migraine
• Severe, throbbing, vascular headache
• Recurrent unilateral head pain
• Combined with neurologic and GI disturbances

3
Migraine Headaches

• 90 of migraine sufferers report nausea.
• Sensitivity to light, sound, and stimulation are
  also common.

4
Migraine Headaches

• Components of classic migraine (all five not
  experienced by every migraine sufferer)
• Prodrome
• Aura
• Headache
• Headache relief
• Postdrome

5
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

6
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

7
Migraine Headaches

• Headache and Headache Relief
• Headache generally dissipates in six hours, but
  may last one to two days

8
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

9
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.

10
Migraine Headaches

• Hormonal fluctuations
• Atmospheric changes
• Environmental irritants

• Causative Factors

• Diet
• Stress
• Depression
• Sleep habits
• Certain medications

11
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

12
Migraine Headaches

• Prophylactic Therapy
• Attempts to prevent or reduce recurrence
• Abortive Therapy

13
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

14
Migraine Headaches

• Prophylactic Therapy
• Anticonvulsants
• Beta blockers
• Calcium channel blockers
• Estrogen
• NASAIDs
• SSRIs
• Tricyclic antidepressants

15
Abortive therapy

• TriptansSelective 5-HT Receptor Agonists
• almotriptan
• eletriptan
• frovatriptan
• naratriptan
• rizatriptan
• sumatriptan
• zolmitriptan

16
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

17
rizatriptan

• Sublingual tablet, quickly absorbed
• Has most rapid onset of action of all oral
  migraine therapies

18
Abortive therapy

• Ergot Preparations (vasoconstictors, but can
  induce vomiting)
• dihydroergotamine
• ergotamine
• ergotamine-caffeine (Cafergot)

19
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

20
Abortive therapy

• Opiod Analgesic
• Butorphanol, tramadol
• Beta Blocker
• propranolol

21
butorphanol

• Nasal spray is used more commonly than injection
• Has analgesic properties for moderate-to-severe
  pain
• Can be addictive and is abused

22
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

23
Drug combination

• Combination of analgesic, sedative, and
  vasoconstrictor may be used.
• Has fewer side effects than ergotamines, but may
  be less effective.