ehab samara fedaa matanes. pain concentrated on one side of the head a debilitating neurobiological...
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Ehab Samara Fedaa Matanes
Mechanism still debatedCommon triggers
Hormonal: Estrogen and Progesterone
Foods: alcohol, chocolate, etc.
Stress, physical activity, sleep
Environmental stimulus: sight, smells
medications
Prodrome Occurs hours to days
before migraine without headache
Aura Neurological phenomena
such as disturbance of vision just before headache
Pain phase Headache on one side of
head with nausea, photophobia and other classic migraine symptoms
Postdrome Exhaustion, irritability,
depression
Herbal brews and folk practices 1200 BC: Egyptians – clay crocodile &
magic herbs10th century: Arabian physicians – garlic or
hot iron to incision at templeMid-1600’s: Dr. Thomas Willis – enemas,
blood letting, leeches, and natural products 1870’s: cold bandage on head, quiet room,
and sleep
1868: use of ergot in the treatment of one-sided headache
Ergot: potent neurotoxin & vasoconstrictor found in a fungus that grows on rye
1925: identified active chemical of ergot (ergotamine)
1940’s: ergotamine tartrate became the preferred treatment for acute migraine
Non-specificAspirin, NSAIDs, Antidepressants, Calcium
channel blockers Ergots-Ergotamine5-hydroxytryptamine (5-HT) agonists
Sumatriptan (imitrex)ZolmitriptanNaratriptanRizatriptan
First choice drug to treat mild to moderate migraine attacksAs we know, aspirin inhibits COX-1, stopping
prostaglandin synthesis from arachidonic acidaspirin also shows inhibitory effects on how the
trigeminal nerve processes inputs (reduces pain)
Structurally similar to amines, serotonin, norepinephrine, and dopamine
interact with multiple receptors in these systems
cause constriction of the blood vessels
wide-range of effects Problems: avoid if patient has coronary
disease; safety margin is small; overdose
A group of drugs known as triptans bind the serotonin 5-HT1B receptors in the walls of blood vesselsLeads to constriction of arteries, particularly at
cerebral and dura arteries Triptans also inhibit inflammation of
vessels of the dura matter that are stimulated by the trigeminal ganglionDo this by acting as a 5-HT1D receptor agonist
Acts on receptors at smooth muscle cells of brain vessels (also in peripheral blood vessels like coronary artery)
The first selective serotonin agonist approved for the treatment of migraine
Rapid reliefTriptans are an advance over ergots Relieves pain of migraine and associated
symptoms3 dosage forms: oral, nasal, & parenteral
Side effects: Change in taste Discomfort in the jaw or mouth Dizziness Drowsiness Lightheadedness muscle aches nausea or vomiting
Rare side effects: Severe chest pain Convulsions Swelling of the eyelids Shortness of breath and trouble breathing
Oral bioavailability improved to ~50% (sumatriptan 14%)
half-life of 3 hours take orally at the onset of headache pain
Side effects: Dizziness Nausea Sleepiness Muscle weakness Chest pain
Rare side effects: Severe abdominal pain Irregular heartbeat Fever or chills Loss of appetite Agitation Anxiety Depression
may cause serious side effects in some people, especially those with a heart or blood vessel disease
Oral bioavailability improved to ~60%half-life of 5-6 hours take orally at the onset of headache pain
not as effective as sumatriptan, but has fewer side effects
Side effects: Dizziness Nausea Sleepiness Muscle weakness Chest pain
Rare side effects: Acne or skin rash Anxiety Blurred vision Tiredness Irregular heartbeat
Oral bioavailability ~40%half-life of 2.5 hours shows the fastest time of onset!
Side effects: Dizziness Nausea Tiredness Hot flashes Chest pain Shortness of breath
Rare side effects: Agitation Anxiety Blurred vision Chills Confusion Insomnia Irregular heartbeat
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