Dr Zubaidah Al asadi MBChB MSc pharmacology December 2022 2 Total number of slides 18 3 Migraine The typical migraine headache is usually unilateral and throbbing aggravated by physical activity ID: 1032103
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1. Drugs for headache disorders Dr. Zubaidah Al asadi M.B.Ch.B MSc pharmacologyDecember 2022
2. 2Total number of slides 18
3. 3 MigraineThe typical migraine headache is usually unilateral and throbbing, aggravated by physical activity.Females more than males Usually lasts 2-72 hours Nausea, photophobia & phono-phobiaThe aura is immediately precedes the headache (visual e.g. flashes, zigzag lines, blurred vision), sensory or motor symptoms
4. 4Biologic basis of migraine headachesMigraine may begin when blood vessels in the brain contract and expand inappropriately. Reduced blood flow triggers the aura. Then blood vessels dilate causing throbbing headache.Serotonin is implicated in its pathogenesis. Triptans & ergots are 5-HT1 receptor agonists activate serotonin receptors to stop migraine attack by vasoconstriction or inhibition of proinflammatory peptides in cranial BVs
5. 5Three areas of management:Avoidance of triggering factors: Stress, alcohol, certain foods (chocolate, cheese, ice cream) , bright lights, noises.2. Symptomatic treatment of acute attack (Abortive therapy):More effective if given early3. Prophylactic (preventive) therapy
6. 6A. Non-specific Drugs The first line of treatment: Analgesics (paracetamol or NSAIDs e.g. aspirin, ibuprofen, naproxen) Corticosteroids Prochlorperazine, metoclopramide or domperidone are usually used with the analgesic drugs Drugs Used For Acute Attack
7. 7B. Specific Drugs: Triptans and Ergots 1. Triptans (Selective 5-HT1 agonists) They are effective first line treatment for moderate to severe headache or after failure of analgesics. They are used if there are no cardiovascular contraindications
8. 8Selectively stimulates 5-HT1 receptors (1B/1D) that exists in cranial blood vessels causing them to constrict Rapid oral absorption with extensive first pass metabolism For rapid response, it can be given subcutaneously, intranasally Headache commonly recurs within 24-48 hours, a second dose is effective. Sumatriptan
9. 9malaise, fatigue, Sedation, vertigo Nausea and vomiting are less than ergots Feeling of chest pressure and pain due to coronary artery spasm (in 5%) Contraindicated in patients with ischemic heart disease, and previous MI Adverse reactions of sumatriptan
10. 10Currently available sublingually. More effective when used early.It also available as an oral tab. or suppository containing ergotamine & caffeine.Dihydroergotamine is used I.V or intranasally.Ergotamine is used with strict daily & weekly dosage limits due to dependence & rebound headahe.Contraindicated in pregnancy, angina & PVDIt should not be used for prophylaxis Ergotamine
11. 11Indicated if 2 or more attacks/month & if complicated by serious neurological signsBeta blockers are the drugs of choice: propranolol & metoprololAnticonvulsants: topiramate, valproateTricyclic antidepressants: amitriptyline Calcium channel blockers: verapamilSerotonin antagonistsProphylactic Therapy
12. 12Drugs for tension & cluster headacheParacetamol, aspirin, naproxen & ibuprofen are used for tension headacheCan be combined with caffeine or barbiturate for tension headacheInhalation of 100% oxygen and sumatriptan are used as first line abortive treatment for cluster headache
13. 13Questions
14. 14The following drugs are indicated for migraine prophylaxis except:VirapamilPropranololAmitriptylineAnticonvulsantsErgotamine
15. 15Which of the following drugs for migraine is contraindicated in patients with peripheral vascular disease?AspirinAcetaminophenNaproxenErgotamineverapamil
16. 16All of the followings are true about triptans for migraine treatment except:Selective 5-HT1 agonistsContraindicated in patients with ischemic heart diseaseSafe in patient with angina pectorisFeeling of chest pressureVasoconstriction is less than ergotamine
17. 17One of the following drugs is used for prophylaxis of migraine:ErgotamineSumatriptanCaffeinePropranololDomperidone
18. 18One of the following drugs is effective in acute attack of migraine:PizotifenPropranololSodium valproateSumatriptanClonidine
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