Medical Treatment and Therapy for Migraine

Treatment and Therapy Migraine

Migraine Treatment Targets
Migraine treatment and therapy goals depends on length and intensity of pain, symptoms comorbidities, degree of disability and the start of treatment response and may also be found in other diseases such as epilepsy, anxiety, stroke, myocardial infarction. Because it must be wary of the medicine. When there are symptoms of nausea/vomiting, the medicine is given rectally, nasal, subcutaneous or intravenous.

Medical Treatment and Therapy of Migraines
Procedures for the treatment of migraine can be divided into 4 categories :
A. The general steps
B. Abortive therapy
C. Step relieve pain
D. Preventive Therapy

A. General Steps
Need to avoid precipitating pain, such as changes in sleep patterns, diet, stress and daily routine, bright light, flashing the weather changes, is in place high as a mountain or in an airplane.

B. abortive therapy
1. In mild to moderate attacks or severe attacks that respond well to the same medications can be used: analgesics OTCs (Over The Counters), NSAIDs (oral)
2. If no response to NSAIDs, specific drug use such as: Triptans (naratriptans, rizatriptan, sumatriptan, zolmitriptan), Dihydro ergotamine (DHE), Drug combinations (mis.nya: aspirin and caffeine asetaminophen), ergotamine drugs stop HIV
3. The patient with response to the above medications, can be used opiate analgesics containing butalbital

In the table below are listed the list of non-specific drugs for mild to moderate migraine attacks. Monitor in order not to "over- use" that trigger a "rebound headache " .


Ketorolac, have a faster effect (+ 6 hours) relief of pain.
Metoclopramide relief of pain accompanied by nausea, vomiting and gastric motility repair, enhance drug absorption in the gut and effective in combination with iv dihidroergotamine Prochlorperazine also relieve pain. Isomethepten combination, acetaminophen and dichloralphenazone for mild attacks.
Steroids is the "drug of choice" for migrainosus status as dexametasone, methyl prednisone.
Specific abortive migraine drugs:
􀁸 Ergotamine and derivatives
Drug use is limited, because it causes pain "over use" and increase the frequency of attacks and the negative effects of air-to-bat preventive medicine.


The combination of ergotamine and caffeine 􀁸 available oral and suppository
􀁸 DHE (dihydroergotamine) alkaloids suitable for severe migraine,
available parenteral drugs and nasal sprays have oxytocic effects and peripheral vasoconstriction that is not given to long-term.
Triptans 

􀁸
For moderate to severe migraine or mild to moderate migraines that do not respond to analgesics or NSAIDs.

- Sc Sumatriptan is more effective because it quickly achieve therapeutic effects ( + 15 min ) in 70-82 % of patients.
Patients should try one drug to attack 2-3 times before wanting to change drug with other types of triptan

C. Steps to Eliminate Pain :
Abortive therapy may not be a complete pain relief, analgesic NSAIDs may be needed. OTCs FDA recommended drug is a combination of aspirin 250 mg, acetaminophen 250 mg and caffeine 65 mg . Ketoralac tromethamin "non- narcotic, non- habituating" can be used, minimal side effects, the dose of 60 mg im Narcotic analgesics, anti- emetics, pheno - tyhiazines, and cold compresses can reduce pain. Narcotic analgesics (codeine, meperidine HCL, methadone HCL) administered parenterally, effective relief of pain, just cause dependence. Anti- emetic was given parenterally or suppository (phenergan, chlopromazine and prochlorperazine) have sedative and anti- nausea effect .
Transnasal butorphanol tartrate administered parenterally. Provision of effective nasal mucosa due to the nature of the nose more readily absorb.



D. Preventive Therapy
The general principle of preventive therapy:
1 . Reducing the frequency and duration of severe attacks
2 . Improving the patient's response to treatment
3 . Increasing daily activities , as well as a reduction in disability

 . Indications preventive therapy , based on the following factors :
1 . Recurrent attacks are disturbing activities
2 . Headache is often
3 . There are contraindications to therapy of acute
4 . Failure of therapy or " over- use"
5 . Severe side effects in the treatment of acute
6 . Costs for acute and preventive therapy
7 . Expected patient craving
8 . The emergence of the symptoms and conditions of outstanding , eg hemiplegic migraine basilar , prolonged aura

Migraine Prevention Formula .
- Use of medication :
The lowest effective dose is raised slowly ( start low go slow ) until the effective dose . Clinical effect is achieved after 2-3 months
- Education of the patient :
Regularly take medications , need a rational discussion about treatment , side effects .
- Evaluation :
" Headache diary " is a " gold standard " evaluation of attack , frequency , duration , severity of attacks , disability and drug response
- The condition of other diseases :
Care being suffered abnormalities such as stroke, myocardial infarction, epilepsy and anxiety , the patient was pregnant (teratogenic effects), caution against drugs interactions.

Preventive therapy Migraine Algorithme

Preventive medicine based on consideration of the condition of the patient .
- 􀁅 - blockers , decrease the frequency of attacks
Contraindications asthma sufferers, diabetes mellitus, diseases
peripheral vascular, heart block, pregnant women .
- Calcium - channel blockers, the effect is rather slow until a few months reduced the frequency of attacks +50 %. Contra indications: pregnant women, hypertension, arrhythmia and "congestive heart failure"
- Serotonin receptor antagonists, (pizotifen) effectively reduced the frequency by 50 % -64 % , side effects lethargy, increased weight
- Methysergide, for the prophylaxis of severe attacks , which do not respond to drugs abortive
Contra indications: hypertension, liver abnormalities, kidney, lung, heart, pregnancy, thrombophlebitis .
Side effects: nausea, stiff muscles, cough, hallucinations. Its used is not more than 6 months .
- tricyclic
Amitriptiline dose is 25mg to 50mg per night.
Nortriptiline anticholinergik effect ngantuknya lower.
Contra indications : liver abnormalities, kidney, lung, heart, glaucoma, hypertension
- Anti - epileptics drugs
Sodium Valproate, Valproic acid effectively. The side effects of nausea, tremors, alopecia. Topiramate proved good 50 % of patients with a dose of 2 x 100mg/hari reduce attacks + 26.3 % .
Side effects asthenia, tremor, dizziness, ataxia, weight decreased. Gabapentin at a dose of 900-2400 mg / day decrease the frequency of attacks 46 %

Source:

1. pict: http://tmedweb.tulane.edu/pharmwiki/doku.php/migraine_medications

2. pict: http://www.dizziness-and-balance.com/disorders/central/migraine/mav.html