Migraine: Management and Treatment with Herbal Drugs
Vikas Kumar, Addepalli Veeranjaneyulu in Herbs for Diabetes and Neurological Disease Management, 2018
Migraine is characterized by episodes of head pain that is often throbbing and frequently unilateral and may be severe. In migraine without aura (previously known as common migraine) attacks are usually associated with nausea, vomiting, or sensitivity to light, sound, or movement and when treated, the attacks typically last 4–72 h. A combination of features is required for the diagnosis, but not all features are present in every attack or in every patient. These symptoms distinguish migraine from tension type headache, the most common form of primary headache, which is characterized by the lack of associated features. Any severe and recurrent headache is most likely to a form of migraine and to be responsive to antimigraine therapy.20 In 15% of patients migraine attacks are usually preceded or accompanied by transient focal neurotic symptoms, which are usually visual; such patients have migraine with aura (previously known as classic migraine).21,22 In a recent large population-based study, 64% of patients with migraine had only migraine without aura, 18% had only migraine with aura and 13% had both types of migraine (the remaining 5% had aura without headache).
The Child With Vomiting
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
Management focuses on prevention and treatment of episodes. The first step is learning to recognise any triggers associated with episodes and the avoidance of identified trigger factors. If stress is an identified trigger, counselling and stress reduction techniques may be helpful. Prophylactic treatment is indicated if the child is having more than one episode per month, episodes last more than 24 hours, are severe enough to require hospitalisation or fail to respond to abortive treatments. Treatment options include anti-migraine agents, prokinetic medications and anticonvulsants. Children with a history of migraine or a family history of migraine often respond well to antimigraine prophylaxis and so should be started on this as first line. Sumatriptan, taken at the onset of symptoms, has been shown to decrease the frequency, duration and intensity of episodes. Ondansetron can be given to reduce the severity of vomiting. The main complication is the risk of dehydration. Families should be educated about the signs of dehydration and when to seek medical attention.
Migraine: diagnosis and treatment
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Pizotifen is a benzocycloheptathiophene derivative that is structurally similar to cyproheptadine and the TCAs. It has a long elimination half-life (about 23 hours) and can be given as a single evening dose. Pizotifen is a 5-HT2 and histamine-1 antagonist with the side-effects of drowsiness and increased appetite with associated weight gain. Pizotifen has proven effective in controlled117 and placebo–controlled118–120 trials. In an open trial, it was less effective than methysergide121 but more effective than placebo. In another placebo–controlled trial, it was as effective as naproxen sodium, and both were more effective than placebo. Pizotifen (2–3 mg) daily was as effective as fiunarazine 10 mg daily. Pizotifen is often used for adolescent migraineurs at doses of 0.5–1.5 mg daily. Adults, in contrast, may require up to 3 mg daily. Pizotifen has no interaction with specific antimigraine compounds, such as ergotamine or the triptans. Pizotifen is not available in the USA.
Treating status migrainosus in the emergency setting: what is the best strategy?
Published in Expert Opinion on Pharmacotherapy, 2018
László Vécsei, Délia Szok, Aliz Nyári, János Tajti
The difficulties of effective therapy stem from the unclear exact pathomechanism and genetic background of migraine. One of the leading hypotheses of the pathogenesis of the initiation and maintenance of a migraine attack emphasizes the activation and sensitization of the trigeminovascular system via the involvement of different neuropeptides. Currently, a few specific (such as serotonergic agents (i.e. DHE and triptans)) and nonspecific (such as NSAIDs and antiemetics) acute antimigraine drugs are available. The weakness of this therapeutic regime is that they are not effective in every single attack and migraineur. Even more, the available medications may have adverse events, which can result in intolerability and loss of patient adherence. Concomitant diseases can contraindicate the use of these pharmacons. These unfavorable conditions can lead to the admission of these seriously ill migraineurs to the ED.
CGRP inhibitors for migraine prophylaxis: a safety review
Published in Expert Opinion on Drug Safety, 2020
Eduardo Rivera-Mancilla, Carlos M. Villalón, Antoinette MaassenVanDenBrink
Migraine is a complex neurovascular disorder that requires specific drugs for its acute or prophylactic treatment. However, many patients use nonspecific drugs to alleviate migraine-related pain or symptoms (i.e. nonsteroidal anti-inflammatory drugs, analgesics, or a combination of both). In an attempt to improve the quality of life of migraine patients, new drugs have been developed in order to reduce the side effects produced by the classical antimigraine drugs (e.g. ergots and triptans). In this respect, the association of CGRP with the pathophysiology of migraine has led to the development of specific drugs that directly block CGRP or its receptor (see Figure 1). These drugs have been shown to be safe in the short-term prophylactic antimigraine treatment. However, their mechanism(s) of action and their long-term effects with reference to safety have not yet been explored. Consequently, there are still some pending issues (described right below) to ensure the safety of these novel prophylactic antimigraine drugs.
Safety of drugs used for the treatment of migraine during pregnancy: a narrative review
Published in Expert Review of Clinical Pharmacology, 2023
Jessica A Spiteri, Gabrielle Camilleri, Carlo Piccinni, Janet Sultana
Several effective antimigraine medications are reasonably safe for use by pregnant women. For the acute episode, acetaminophen remains a recommended first-line agent although concerns with its possible association with negative endocrine and neurodevelopmental outcomes cannot be ignored and require further research. NSAIDs in the first trimester, with perhaps exception of ibuprofen, have been associated with spontaneous abortion. They do not seem to be major teratogens although the available evidence is less clear on this point. While as a class they seem safe during the second trimester, they are less so beyond 20–30 weeks and are associated with adverse neonatal renal and vascular effects. Triptans seem not to be associated with congenital malformations or spontaneous abortions with sumatriptan being the drug with most evidence behind it. Ergot alkaloids remain contraindicated in pregnancy and have lost their role in migraine management in general due to the advent of better alternatives.
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