MIGRAINE AND THE DRUGS USED IN THE TREATMENT

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WELCOME

MIGRAINE AND THE DRUGS USED IN THE TREATMENT OF MIGRAINE:

MIGRAINE AND THE DRUGS USED IN THE TREATMENT OF MIGRAINE Presented by Ch.Malathi Suvarna , Y11MPH15103

CONTENTS::

CONTENTS: INTRODUCTION MIGRAINE PATHOPHISIOLOGY OF MIGRAINE ANTIMIGRAINE DRUGS DRUGS FOR MIGRAINE

INTRODUCTION ::

INTRODUCTION : Migraine is a common and debiliating condition affecting 10-15% of people. Migraine is a mysterious disorder characterised by pulsating head ache, usually restricted to one side which may last from 4-48 hrs & is often associated with nausea , vomiting , photophobia , virtigo , etc.,

MIGRAINE ::

MIGRAINE : It is of two major types

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Three theories are explaining the migraine but none of them have really suceeded in explaining it. They are

PATHOPHYSIOLOGY OF MIGRAINE::

PATHOPHYSIOLOGY OF MIGRAINE: Pulsatile dilation of certain large cranial vessels is the immediate cause of pain. It may also be due to shutting of blood through carotid arterio-venous anastomoses produces cerebral ischemia & starts the attack. It may be a spreading depression of cortical electrical activity followed by vascular phenomena. Release of mediators like 5HT, Neurokinin, substance P, calcitonin gene related peptide nitric oxide, etc.,

ANTIMIGRAINE DRUGS ::

ANTIMIGRAINE DRUGS : Based on the severity and frequency of the attack the therapy will be choosed.

Drugs for migraine::

Drugs for migraine: To treat mild migraine the following drugs are being used. Simple analgesics Nonsteroidal antiinflammatory drugs Antiemetics

Drugs for migraine::

Drugs for migraine: The severe migraine is being treated by Ergot alkaloids Antiemetics Β -blockers

Drugs for migraine::

Drugs for migraine: The moderate migraine is being treated by NSAID’s combination Ergot alkaloids 5HT Agonists

Drugs for migraine::

Drugs for migraine: Of all Ergotamine is the most effective drug to treat migraine. It acts by constricting the dilated cranial vessels appearing to be mediated by partial agonism in and around the vessels. It is given by oral or sublingual route upto 6mg at half an hour interval till relieved. Must not be given parentarally as it is hazardous. This is generally preffered in case of the early attack.

Drugs for migraine::

Drugs for migraine: Dihydroergotamine is another drug which is as effective as the ergotamine. This can also be administered by the parentaral route. Several other calsses of drugs are also being used based on the frequency of the dosage. β -Adrenergic blockers like propanolol are being used to reduce the frequency to of attacks. Its starting dose is 40mg & may be increased to 160mg.

Drugs for migraine::

Drugs for migraine: Those blockers having an intrinsic sympathomimetic action such as pidolol are not used. Tricyclic antidepressants such as Amitriptyline are most extensively tried, they are much more effective in case of patients who also suffer from depression. The Calcium channel blockers like Verapmil are also being used, they are acting by reducing intracellular Ca +2 overload due to brain hypoxia.

Drugs for migraine::

Drugs for migraine: Anticonvulsants like Valproic acid were used but newer ones like Topiramate are noted to reduce the attacks to half . Its dosage usually starts at 25mg & may be increased to 50mg. The 5HT- antagonists are seldom used and they are very less effective when compared with β - blockers. Selective 5HT agonists like sumatriptan & rizatriptan are used as they act on same receptor as the ergot alkaliods with a different pharmacodynamics.

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THANK YOU