Manbir Online .. Migraine

Migraine is an episodic unilateral headache accompanied by visual disturbances and vomiting. The episodic nature of the headache is most characteristic. initially during aura, there is a decrease in cerebral blood flow, particularly in the occipital and parietal lobes. Later, during the phase of headache there is a dilatation of the extracranial arteries related to the variations in 5-HT blood levels.

Types of migraine

1. Classical migraine. The headache is preceded by visual or sensory aura.

2. Common migraine. This is without aura. Headache, nausea, vomiting and photophobia are the classical symptoms.

3. Hemiplegic migraine. In this type, hemiplegia lasting for a few days follows the headache.

4. Basilar migraine. Vertigo, diplopia, dysarthria with or without visual symptoms precede occipital headache.

5. Cluster headache. Bouts of severe pain around one eye with associated epiphora and nasal congestion is the hallmark and this type mostly affects males.

Treatment

Treatment of migraine involves managing acute attacks with analgesics and prevention of further attacks. Precipitating causes have to be taken care of and family and work related stress should be managed by various methods of coping with stress and relaxation and keeping regular hours of sleep and meals habits.

Simple analgesics like asprin, acetoaminophen and also ibuprofen and diclofenac are used to alleviate pain. Ergotamine is used when analgesics give less relief. It acts by causing vasoconstriction of extracranial vessels and reduction of platelets aggregation. Sumatriptan is a highly selective 5-HT1 receptor agonist which are mainly located in cerebral arteries. It constricts cerebral blood vessels.

Dopamine antagonists, metoclopramide, chlorpromazine, prochlorperazine have been used for severe attacks.

Narcotics and short course of corticosteroids and antipsychotics can be used when severe migraine does not respond to conventional mesures.

Drugs used in Migraine

	Ergotamine	Flunarizine	Sumatriptan
Indications	1. Migraine 2. Cluster headache 3.Vascular headache 4. Post-partum haemorrjage	1. Prophylaxis of classical and common migraine. 2. Vertigo and vestibular disorders. 3. Peripheral vascular disorders. 4. Resistant cases of Epilepsy as an adjuvant.	1. Acute severe migrane. 2. Clustur headache.
Contraindications	1. IHD 2. Peripheral Vascular disease. 3. Gangrene 4. Hipatic diseases. 5. Renal diseases. 6. High BP 7. Porphyria.	1. Hypersensitivity 2. Parkinsonism 3. Acute Porphyria	1. Hypersensitivity 2. IHD 3. Uncontrolled BP
Dose	1-2 mg twice or thrice daily.	10 mg / day as a single dose.	50-100 mg. If poor response repeat 100mg every 2 hrly, maximum 300mg a day.
Adverse drug reactions	Nausea/vomiting,diaeehoea, leg cramps,abdominal pain,myocardial ischaemia.	Depression,skin rash, anusea,epigastric disorders, headache, drowsiness, insomnia, extrapyramidal reactions.	Tightness in the chest, skin rash, hives, fatigue, dizziness, wheezing, ocular swelling.