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

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

Migraine Headaches Components of classic migraine (all five not experienced by every migraine sufferer): – Prodrome – Aura – Headache – Headache relief – Postdrome

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

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

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

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

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.

Migraine Headaches Causative Factors Diet Stress Depression Sleep habits Certain medications Hormonal fluctuations Atmospheric changes Environmental irritants

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

Migraine Headaches Prophylactic Therapy Attempts to prevent or reduce recurrence Abortive Therapy

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

Migraine Headaches Prophylactic Therapy – Anticonvulsants – Beta blockers – Calcium channel blockers – Estrogen – NASAIDs – SSRIs – Tricyclic antidepressants

Abortive therapy Triptans—Selective 5-HT Receptor Agonists almotriptan eletriptan frovatriptan naratriptan rizatriptan sumatriptan zolmitriptan

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

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

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

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

Abortive therapy Opiod Analgesic Butorphanol, tramadol Beta Blocker propranolol

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

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

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