 Migraine can usually be distinguished clinically from the two other common types of headaches—cluster headache and tension-type headache—by its characteristics.

Slides:



Advertisements
Similar presentations
Central Nervous System Disorders Unit II Syllabus
Advertisements

Drugs Affecting Uterine Contraction ผศ. พญ. มาลียา มโนรถ.
Mosby items and derived items © 2008, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 8 Xanthines.
1 Copyright © 2012, 2008, 2002, 1998, 1994, 1989, 1984, 1978 by Mosby, Inc., an affiliate of Elsevier Inc. Reminder:  QUIZ NEXT WEEK ON:  Anti-infectives,
Migraine Lecture 2002 Jin-Hyeun Huh Pharmacy Practice Leader TWH, UHN.
 Migraine is a benign and recurring syndrome of headache, nausea and vomiting, and /or other neurological dysfunction.  Migraine, the most common cause.
Migraines Mark Green, MD Clinical Professor Department of Neurology Columbia University New York, NY.
Drugs to treat angina. I. Introduction Branching off the aorta are the coronary arteries.
Prof. Omnia Amin Nayel & Dr. Ishfaq Bukhari. Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs.
Prof. Omnia Amin Nayel & Dr. Ishfaq Bukhari. Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs.
Report by Jonathan Cartney.  Under-diagnosed/under-treated  million people diagnosed each year in the United States (Approx 12 percent of US pop.)
Migraine Headaches Jim Ducharme MD CM FRCP Professor, Emergency Medicine Dalhousie University.
Analgesic and Antipyretic Agents
Drugs That Affect Uterine Function
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 18 Autocoids and Antihistamines.
Anti-migraine Drugs Courtney Geiger Medicinal Chemistry Dr. Buynak November 18, 2004.
8/14/20151 MIGRAINE DR.ABDUL LATIF MAHESAR Department of medical pharmacology KING SAUD UNIVERSITY 1March 2011.
Ehab Samara Fedaa Matanes. Pain concentrated on one side of the head A debilitating neurobiological headache disorder Affects 28 million people in the.
Anti-Migraine Drugs Brian Lich April 3 rd, Overview Migraines: What are they? Symptoms? Causes? Migraines: What are they? Symptoms? Causes? History:
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 30 Drugs for Headache.
MIGRAINE BY PROF, AZZA EL-MEDANY MIGRAINE Recurrent attacks of headache. Unilateral, associated with migraine aura ( anorexia, nausea, vomiting, visual.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 18 Adrenergic Antagonists.
Agents Used in Obstetrical Care
“My migraine always comes back” Presented by: Julio Pascual Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and Ineuropa,
Migraine Headaches Migraine Severe, throbbing, vascular headache
Serotonin or 5-hydroxytryptamine Widely distributed amine (animals + plants) In humans, present in GI enterochromaffin cells (90%), platelets and brain.
Dr.B.V.Venkataraman Professor in Pharmacology Faculti Perubatan, Shah Alam, Malaysia Ph: /
INCREASED INCIDENCE OF REBOUND HEADACHES FROM THE DISCONTINUED USE OF THE ANTI-MIGRAINE MEDICATION, MAXALT ® Sherry Neff Department of Biological Sciences,
Prof. Omnia Amin Nayel & Dr. Abdul latif Mahesar.
Chapter 30 Agents Used to Treat Parkinson’s Disease.
Headache (Chapter 52). Background Headache is the 4th most common symptom of outpatient visits Costs between $1 - $17 billion annually Prevalence highest.
Migraine Headaches Migraine – Severe, throbbing, vascular headache – Recurrent unilateral head pain – Combined with neurologic and GI disturbances.
Chapter 33 Agents Affecting the Autonomic Nervous System.
 Cardiovascular Effects  α -receptor antagonist drugs lower peripheral vascular resistance and blood pressure.  These drugs can prevent the pressor.
Cardiovascular drugs By Dr. fatmah alomary
Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 16 Central Nervous System Stimulants and Related.
Galactorrhea Jack Biko. Galactorrhea Non-pueperal secretion of milk Confirmed by visualizing fat droplets in secretions using low power microscopy.
Serotonin ( 5- hydroxy tryptamine; 5HT ). Serotonin ( 5- hydroxy tryptamine; 5HT ) Locations: Locations: - Gut enterochromaffin cells ( 90% ) - Gut enterochromaffin.
Ergot Alkaloids Dr. Naila Abrar. LEARNING OBJECTIVES After this session, you should be able to: know the source and classification of ergot alkaloids;
Drugs in parkinsonism ilos
Dublin November 13 th 2011 By Dr. Edward O’Sullivan 13-Nov
PHARMACOLOGY OF ANS part 3 General Pharmacology M212
Chili peppers and pain. Capsicum peppers Discovery Early history Botany Member of Solanaceae Capsicum annuum Capsicum frutescens Capsaicin Traditional.
Dr. Ishfaq Bukhari. Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs used to prevent migraine.
Adrenergic Antagonists
DRUGS USED IN UTERINE MOTILITY
 Parkinson’s disease is a neurodegenerative disorder first described by Dr James Parkinson, a London physician, in The underlying cause is loss.
* QUINIDINE  Quinidine has pronounced cardiac anti muscarinic effects. It is absorbed orally. It undergoes extensive metabolism by the hepatic cytochrome.
Julia Presentation by Gemma Veale. Presenting complaint Ongoing migraines Currently taking – amitriptyline 40mg - rizatriptan 10mg.
Treatment of migraine headache. Introduction Migraine is a severe type of unilateral periodic headache characterized by: 1.Prodorme 2.Aura: mild headache,
Non-steroidal anti-inflammatory drugs
Adrenergic Antagonists
MANAGAMENT OF MIGRAINE. Migraine Facts Migraine is one of the common causes of recurrent headaches Migraine is one of the common causes of recurrent headaches.
Headache. Migraine Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 h and may be severe. Pain is often unilateral, throbbing,
Structures rich in 5-HT GIT (chromaffin cells and enteric neurons)
Drugs for Headaches 1.
Serotonin Phase II Spring 2014.
Department of Pharmacology
DRUGS USED IN HEADACHE AND MIGRAINE
Migraine headache is characterized by unilateral , throbbing or non throbbing headache , associated with nausea, vomiting ,photophobia and phonophobia.
Autacoids.
Migraine Headaches Migraine Severe, throbbing, vascular headache
DRUGS USED IN HEADACHE AND MIGRAINE
Dopamine receptor agonists
Antianginal Drugs.
Dr. Aliah Alshanwani Dr. Ishfaq Bukhari Oct 2018
Terms and Definitions Analgesics:
DRUGS USED IN HEADACHE AND MIGRAINE
Adrenergic Antagonist
Therapy of the Acute Migraine Attack. Therapy of the Migraine Attack Criteria for efficacy Pain free after 2 hrs Improvement of headache from severe.
Presentation transcript:

 Migraine can usually be distinguished clinically from the two other common types of headaches—cluster headache and tension-type headache—by its characteristics

Types of migraine  There are two main types 1. Common migraine  Migraine without aura  Approximately 85 percent of patients  a severe, unilateral, pulsating headache  typically lasts from 2 to 72 hours.  often aggravated by physical activity  accompanied by nausea, vomiting, photophobia (hypersensitivity to light), and phonophobia (hypersensitivity to sound).

2. Migraine with aura (classic migraine)  preceded by neurologic symptoms called auras, which can be visual, sensory, and/or cause speech or motor disturbances.  these prodromal symptoms are visual, occurring approximately 20 to 40 minutes before headache pain begins.

 In the 15 percent of migraine patients whose headache is preceded by an aura, the aura itself allows diagnosis.  The headache itself in migraines with or without auras is similar.  For both types of migraines, women are three-fold more likely than men to experience either type of migraine.

Symptomatic treatment of acute migraine  Acute treatments can be classified as A. Nonspecific treatment includes:  Analgesics, such as nonsteroidal anti- inflammatory drugs  Antiemetics, such as prochlorperazine, to control vomiting.  Opioids are reserved as rescue medication when other treatments of a severe migraine attack are not successful.

B. Specific migraine therapy includes:  Triptans  Dihydroergotamine  both are 5-HT 1D receptor agonists.  It has been proposed that activation of 5- HT 1D receptors by these agents leads either to vasoconstriction or to inhibition of the release of proinflammatory neuropeptides. triptans  Despite their high cost, most patients prefer triptans over ergot derivatives.

Triptans:  sumatriptan  rizatriptan  eletriptan  zolmitriptan  almotriptan  frovatriptan  naratriptan

Dihydroergotamine:  a derivative of ergotamine  administered intravenously  has an efficacy similar to that of sumatriptan  nausea is a common adverse effect.

Prophylaxis of migraine headache  Therapy to prevent migraine is indicated if:  the attacks occur two or more times a month  if the headaches are severe or complicated by serious neurologic signs.  Propranolol is the drug of choice, but other β- blockers, particularly nadolol, have been shown to be effective.

Structure  Ergots include a wide variety of compounds sharing the tetracyclic ergoline nucleus that are produced by the fungus Claviceps purpurea.  These agents have a strong structural similarity to the neurotransmitters norepinephrine, dopamine, and serotonin.

 Amine ergot alkaloids include:  ergonovine  methysergide  lysergic acid (LSD)  methylergonovine

 Peptide ergot alkaloids include  ergotamine [Ergomar]  dihydroergotamine [Migranol]  ergocristine  bromocriptine [Parlodel]  pergolide [Permax]

Mechanism of action  Ergots display varying degrees of agonist or antagonist activity in three receptor types: 1.α-adrenoceptors 2.dopamine receptors 3.serotonin receptors

 The pharmacologic application of ergots is determined by the relative affinity and efficacy of the individual agents for these receptor systems.  Many agents exhibit partial agonist activities and thus can cause either stimulatory or inhibitory effects.

Pharmacologic properties  Administration: parenterally, rectally, sublingually, as inhalants, or orally and  vary widely in their absorption.  Amine alkaloids are slowly and relatively poorly absorbed;  Peptide alkaloids are completely absorbed.  Ergots are extensively metabolized to compounds of varying activity and half-life.

Therapeutic uses  Postpartum hemorrhage  Ergonovine [Ergotrate]  methylergonovine [Methergine]  the most uterine-selective agents, cause prolonged and forceful contraction of uterine smooth muscle.  Uterine sensitivity varies with hormonal status; the uterus at term is most sensitive.

Migraine 1. Ergotamine [Ergomar, Ergostat]  is widely used for relief of an acute migraine attack.  The major effect of ergotamine is cerebral vasoconstriction; it reverses the rebound vasodilation that is the probable cause of pain.  Ergotamine acts as an agonist at  a central 5-HT receptor  α-adrenoceptor

 Ergotamine is most effective if administered in the early stages of attack to reverse rebound vasodilation.  Ergotamine is frequently combined with caffeine, which probably increases absorption.  Ergotamine produces long-lasting and cumulative effects; weekly dosage must be strictly limited.

2. Methysergide [Sansert]  is used for prophylaxis of migraine.  Methysergide acts as a serotonin- receptor (5-HT 2A,C ) antagonist,  and it inhibits initial vasoconstriction in the early stages of a migraine.

 Methysergide is effective in 60% of patients for the prophylaxis of migraine  it is ineffective after the onset of an attack.  The cumulative toxicity of methysergide requires drug-free periods of 3—4 weeks every 6 months.

Hyperprolactinemia  Bromocriptine mesylate [Parlodel  Pergolide [Permax]  dopaminergic agonists, cause specific inhibition of prolactin secretion (elevated prolactin secretion can induce infertility and amenorrhea (abnormal absence or suppression of menstruation) in women and galactorrhea (a spontaneous flow of milk) in men and women).

 These agents are used to treat prolactin- secreting tumors of the pituitary, to counteract central dopaminergic antagonists, and to suppress normal lactation.  Bromocriptine mesylate and pergolide are used as adjuncts to agents such as levodopa in the management of Parkinson's disease (not a prolactin-lowering effect).  These agents reduce growth hormone secretion.

Diagnosis of variant angina  Ergonovine produces a diagnostic vasoconstriction of coronary arteries that are prone to vasospasm, as in variant angina.  Ergonovine is administered intravenously (IV) during angiography.

Adverse effects  The most serious adverse effect is prolonged vasospasm; this can lead to gangrene and is most frequently caused by ergotamine and ergonovine.  The most common side effect is gastrointestinal disturbance.  Methysergide toxicity includes  retroperitoneal fibroplasia  coronary and endocardial fibrosis  CNS stimulation and hallucinations.

DrugReceptor Target Tissue and ResponseTherapeutic UsesToxicity Ergonovineα-Adrenoceptor agonist Uterine smooth muscle contraction Postpartum hemorrhage Hypertension, nausea Ergotamineα-Adrenoceptor agonist, 5-HT receptor agonist Vascular smooth muscle; vasoconstriction Acute migraine attacks Nausea, diarrhea Methysergide5-HT receptor antagonist Vascular smooth muscle;prevent initial vasoconstriction Migraine prophylaxis Fibroblastic changes Bromocriptine, pergolide Dopamine agonists Breast, uterus, pituitary; suppress lactation and decrease growth hormone levels Hyperprolactine -mia, amenorrhea, acromegaly Dose-related effects, ranging from nausea to parkinsonian- like symptoms

Kinins  Biosynthesis  Kinins are found in the circulation and tissues as kininogens of high molecular weight or low molecular weight (about 80% of total kininogens).  Specific serine proteases called kallikreins convert kininogens to the active kinins.  Kallikreins are activated by Hageman factor, trypsin, and kinins.

 The major kinins are a group of related peptides with potent actions as vasodilators.  Bradykinin has the following amino acid sequence: Arg-Pro-Pro-Gly-Phe- Ser-Pro-Phe-Arg.  Lysyl-bradykinin (kallidin) has additional lysine residue on the N- terminus of bradykinin.

Therapeutic uses  Aprotinin [Trasylol]  inhibits kallikreins and thus the formation of kinins  it also inhibits other proteases, including plasmin.

 Aprotinin is approved for use during cardiac bypass surgery on the basis of its anticoagulation properties that reduce the amount of blood needed for transfusion during extracorporeal procedures, and in surgery in which the patient is at high risk for excessive bleeding.