1. Migraine Headaches Migraine Severe, throbbing, vascular headache
Recurrent unilateral head pain
Combined with neurologic and GI disturbances
90% of migraine sufferers report nausea.
Sensitivity to light, sound, and stimulation are also common.

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

3. 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.

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

5. 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

6. 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

7. Migraine Headaches Prophylactic Therapy Anticonvulsants Beta blockers
Calcium channel blockers
Estrogen
NASAIDs
SSRIs
Tricyclic antidepressants
sSsSimple analgesics
NSAIDs
Ergotamine-containing medications
Other drugs

8. Abortive therapy 1. Triptans—Selective 5-HT Receptor Agonists
almotriptan
eletriptan
frovatriptan
naratriptan
rizatriptan
sumatriptan
zolmitriptan

9. 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

10. 2. Ergot Preparations (vasoconstictors, but can induce vomiting)
dihydroergotamine
ergotamine
ergotamine-caffeine (Cafergot)
3. 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

11. 4. Opiod Analgesic
Butorphanol, tramadol
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
5. Beta Blocker
propranolol

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