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    Acute Treatment of Migraine: Action

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    Fathy Elsheshtawy
    This document summarizes treatment options for acute and preventive treatment of migraines. For acute treatment, it describes the mechanisms and side effects of triptans, NSAIDs, and dopamine antagonists. For preventive treatment, it outlines several drug classes including beta blockers, calcium channel blockers, antidepressants, and anti-seizure medications. It provides details on specific medications within each class, their indications, side effects, contraindications, and dosing.

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    Acute Treatment of Migraine: Action

    Uploaded by

    Fathy Elsheshtawy
    68 views3 pages
    This document summarizes treatment options for acute and preventive treatment of migraines. For acute treatment, it describes the mechanisms and side effects of triptans, NSAIDs, and dopamine antagonists. For preventive treatment, it outlines several drug classes including beta blockers, calcium channel blockers, antidepressants, and anti-seizure medications. It provides details on specific medications within each class, their indications, side effects, contraindications, and dosing.

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    This document summarizes treatment options for acute and preventive treatment of migraines. For acute treatment, it describes the mechanisms and side effects of triptans, NSAIDs, and dopamine antagonists. For preventive treatment, it outlines several drug classes including beta blockers, calcium channel blockers, antidepressants, and anti-seizure medications. It provides details on specific medications within each class, their indications, side effects, contraindications, and dosing.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    68 views3 pages

    Acute Treatment of Migraine: Action

    Uploaded by

    Fathy Elsheshtawy
    This document summarizes treatment options for acute and preventive treatment of migraines. For acute treatment, it describes the mechanisms and side effects of triptans, NSAIDs, and dopamine antagonists. For preventive treatment, it outlines several drug classes including beta blockers, calcium channel blockers, antidepressants, and anti-seizure medications. It provides details on specific medications within each class, their indications, side effects, contraindications, and dosing.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Acute treatment of migraine

    5HT1 agonists NSAID Dopamine antagonist &


    Non-selective 5HT Selective 5HT (Tryptan) prokinetics
    (ergotamine & DHE)
    Action Non-selective agonist to Selective 5HT1 agonist VC PG synthesis & Antagonize dopaminergic
    5HT1 & dopamine Rs  Inhibition of release of inflam inflammatory mediators activity during initial phase of
    powerful & selective VC of peptide (CGRP) from trigeminal migraine 
    ECA & its branches vascular fibers in the meninges  gastric motility & drug
    absorption
    Nausea & vomiting
    SE 1-Nausea & vomiting 1-Difficulty of breathing Allergy, asthma, GI
    2-IHD or CVD 2-Parathesia bleeding
    3-Frequent use  3-Chest discomfort Long term use 
    transformed headache 4-Local pain transformed headache
    CI 1-IHD & Raynaud’s dis 1-IHD Allergy, asthma, GI
    2-Pregnancy 2- With other VC drugs bleeding & pregnancy
    3-e sumatriptan or BB
    Dose Migranil Imigrane (Sumatriptan) Acetylsalicylic (Aspirin): Chloropromazine
    Tab: (1mg ergotamine + Tab: (50,100 mg) 650mg/4hr (Neurazine): 50-100mg IM
    50 caffeine + 200mg 25-100mg PO, repeat/2hr Acetaminophen No-migrane tab
    analgesic) Amp: (6mg) once SC at onset (Paramol): 650mg/4hr (1mg ergot + 50mg caffeine +
    2tab immediately & Intranasal Ibubrofen (Brufen): 250mg paracetamol + 10mg
    repeted every ½ hr up to 400-800mg tds domperidone)
    6tab/d Indomethacin (inocid): Metoclopramide
    Rectal: 50mg tds Domperidone
    1 supp immediately & Naproxen (Naprosyn)
    repeted every 1 hr up to 750mg/d
    2supp/d
    Other tryptans: Indication:
    1-Naratryptan 1st choice in cases with:
    2-Eletryptan 1) IHD
    3-Zolmitryptan (No-migran) 2) HTN
    4-Rizatryptan 3) Vascular claudication
    Prophylactic treatment of migraine
    5HT2 antagonist NSAID B blockers Ca channel blocker Antidepressant GABAergic drugs
    Methyergide Cyproheptadine Naproxen Propranolol Flunarizine (sibelum) Na valproate
    (Deseril) & pizotifen (Naprosyn) (Inderal) Verapamile (isopten)
    Tolfnamic acid Atenolol Nimodipine
    (Tolectin) (Tenormin) (nimotop)
    Actn Prevent VC so prevent migraine PeripheralPG 5HTAB Membrane stabilizing Inhibit 5HT & NA Peripheral
    attack synthesis antagonism effect reuptake inhibit TVS
    Central -- 5HT NO antagonism Amitriptyline Central brain
     B blocking inhibit trigeminal GABA level
    neuron activation
    Ind Sever refractory Drug of choice in Episodic Migraine Migraine associated Transformed First-line if BB is
    migraine prophylaxis in prophylaxis not associated with with HTN headache CI as asthma, HF
    children long-term stress & HTN CI for B blockers Migraine with
    prophylaxis d2 SE insomnia
    SE Weight loss Less SE Impotence Flunarizine:
    Retroperitoneal, (Wt gain & Fatigue a) Extra-pyramidal
    pleuropericardial or drowsiness) Depression b) Wt gain
    subendocardial Memory dist Verapamile:
    fibrosis Orthostatic a) Arrhythmia
    Blpr
    CI IHD 1-Asthma Flunarizine:
    e sumatriptan or 2-CHF a) Depression
    BB 3-Arrythmia b) PD
    Verapamile:
    a) AV block
    Dose 2mg tid Inderal Sibelum 5-10mg/d Tryptizol Depakine
    10-40 mg/d Isopten 30-60mg/d 10-25mg/d 250-500mg/d
    Tenormin Nimotop 30-60mg/d (10mg tryptizol at
    50-200mg/d night & 10mg
    Inderal in the
    morning)
    7) Miscellaneous:
    a) Clonidine (catapress): a2 agonist
    b) Riboflavin: for possible altered mitochondrial energy metabolism if ass with MELAS
    c) Mg

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