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أدوية الشقيقة... MIGRAIN DRUG MANEGMENT
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FOR ACUTE ATTACKS:
- Ergot alkaloids: Ergotamine or Ergotamine with Caffeine.
-Serotonin Agonists: Sumatriptan.
-Analgisics: Paracetamol, Aspirin, Codeine
-Combination: Metoclopramide with Paracetamol.
-Antiemitics: Metoclopramide, Buclizine.
FOR PROPHYLAXIS:
- Beta adrenargic blockers: Propanolol, Atenolol, Metoprolol, Nadolol.
-TCA ( tricyclic antidepressant): Amitriptyline, Doxipen, Imipramine, Nortriptyline.
-Serotonin antagonists: Methysergide, Pizotifen, Cyproheptadine.
-Anticonvulsents: Valproic acid.
Sumatriptan
-It results in stimulation of 5HT-1D receptors causes vasoconstriction in the cranial blood vessels.
-It is highly effective, but contraindicated in patient with sever hypertensions & ischemic heart disease.
-It should be given as soon as possible after the start of attack( 6mg subcutaneously or 50-100mg orally).
-It should not be taken until 24 hours after ergotamine. Similarly, ergotamine should not be taken until 6 hrs after Sumatriptan.
Ergotamine & Dihydroergotamine:
-It is used with patients who don’t respond to analgesics.
-Most effective when given early in an attack , specially during the prodormal phase.
- It is an alpha-antagonist, a weak anti-serotonin, and a direct vasoconstrictor.
-It relieves headache by constricting the cranial arteries.
-Visual and other prdormal syndromes not relieved & vomiting may become worse.
-Thus, vomiting can be relieved by adding anti-emitics.
-A combination of ergotamine & caffeine is preferred, as caffeine causes vasoconstriction of cerebral blood vessels.
-Side effects: vomiting, nausea, abdominal pain, muscular pain,…
- It is available as oral & sublingual tablets, & injectable form for intramuscular & subcutaneous injections.
Analgesics & Antiemitics:
-Used for symptomic relief during acute attacks.
-Antiemitics, especially Metoclopromide, not only control vomiting but also remove the stasis & thus increases the absorption of analgesics’.
Beta adrenargic blockers:
-Improvement after 4 weeks or more.
-Its value is limited by its contraindications.
Antidepressants:
-It produces more rapid improvement within 4 weeks.
-Sid effects includes:
Anticholinargic effects, sedation, tremor, postural hypotension, weight gain, agitation, seizers…
Methysergide
-It is 5HT-2 antagonist.
-If patient don’t respond to propranolol, Methysergide can be tried.
-If effective it should be given in minimum dose of 1-2mg for 6 months at a time.
- Important: long term use of Methysergide may be associated with retroperitoneal fibrosis
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