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

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

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

5. 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

6. 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

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

8. 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

9. 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.

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

11. 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

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

13. Migraine Headaches Prophylactic Therapy Abortive Therapy
Attempts to prevent or reduce recurrence
Abortive Therapy
Treats acute migraine attacks
Taken after headache occurs, at first sign of a headache

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

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

16. 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

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

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

19. 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

20. Abortive therapy Opiod Analgesic Butorphanol, tramadol Beta Blocker
propranolol

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

22. 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

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