ANTIMIGRAINE DRUG Mdm.

Shamima
L.O: Define and classify migraine Describe the pathophysiology of migraine Classify anti migraine drugs Describe each anti migraine drugs

MIGRAINE
define A severe headache felt as a throbbing pain at the front or on one side of the head.

Stages

1. 'Prodromal' (preheadache) stage. 2. Aura.

changes in mood, energy levels, behavior and appetite, and sometimes aches and pains several hours or days before an attack. sensation, or aura, just before their migraine starts. Symptoms of aura include flashes of light or blind spots, difficulty focusing, and seeing things as if you are looking through a broken mirror. This stage normally lasts around 15 minutes to an hour. pulsating or throbbing pain on one side of the head.usually have nausea or vomiting, and extreme sensitivity to bright light and loud sounds, with a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours. Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms. There may be a stage of exhaustion and weakness afterwards.

3. Headache stage.

4. Resolution stage.

5. 'Postdromal' or recovery phase.

Pathophysiology Theories:

1. vascular theory

The humoral-vascular theory postulates that circulating vasoactive amines constrict the corticol microcirculation, thus causing the neuralgic symptoms and signs classic of migraine and that a subsequent phase of dilatation (predominantly extracranial) is responsible for headache. Dilatation of extracranial, middle meningeal, or cerebral arteries is thought to cause pain in migraine because the vessel wall has been sensitized by the absorption of serotonin released from platelets and the periarterial accumulation of histamine and bradykinin, causing sterile inflammatory response around extracranial vessels.

2. neurogenic theory

ANTIMIGRAINE
DRUGS Acute attack 1. nonspecific: Analgesic / NSAIDs : aspirin & paracetamol antiemetic eg metoclopramide 2. migraine- specific Triptan groups Ergotamine -- dihydroergotamine prophylaxis Pizotifen -adrenoceptor antagonist Tricyclic antidepressant Methysergide

Effect of the drug

These drugs are believed to owe their anti-migraine efficacy to direct vasoconstriction of dilated cranial blood vessels (1) Inhibition of TGN-induced cranial vasodilatation (2) Plasma protein extravasation (3) and / or central neuronal activity (4) Only lipophilic, brain penetrant triptans (not sumatripans) exert central TGN inhibitory effects. TNC Trigeminal nucleus caudalis.

ACUTE DRUGS 1. triptans Selective competitive agonist 5-HT 1D receptor Includes: Sumatriptan Naratriptan Rizatriptan Eletriptan Almotriptan zolmitriptan MOA Side effects The 5-HT1 receptor is present on the human basilar artery and in the vasculature of human dura mater agonists produces vasoconstriction and inhibition of pro-inflammatory substance release Chest pain Change in taste Discomfort in the jaw or mouth Dizziness Drowsiness Lightheadedness muscle aches nausea or vomiting Ischemic heart diseases

Contraindicated

 2) Ergotamine

Dihydroergotamine MOA

Derivatives of ergotamine Non-selective 5-HT1 & 2 agents 5-HT2 antagonist blocks the vasopressive effects of serotonin as well as effects on extravascular smooth muscle vasoconstriction Nausea Pregnancy Patients with peripheral vascular disease Coronary artery disease Simple analgesic Inhibition of PG release

Side effects Contraindicated

3) Aspirin

MOA

PROPHYLAXIS DRUGS Used in cases with more than one severe attack per month Common drugs Pizotifen Propranolol Amitryptiline Methysergide Retroperitoneal fibrosis Renal failure