Headache prevention, treatment

Preventive treatment should be considered if headache frequency is more than two per week, duration is greater than 3 to 4 hours, or severity results in medication overuse or substantial disability. 

As investigations in recent years have shown that serotonin may play an important role as a transmitter substance, Deseril will undoubtedly contribute to the elucidation of the functions of serotonin in the organism. Investigations have already shown that it exerts very beneficial effects in the preventive treatment of migraine and other vascular headaches... 

Consistent with the hypothesis that 5-HT is a key mediator in the pathogenesis of migraine, 5-HT receptor agonists have become the mainstay for acute treatment of migraine headaches. New treatments for the prevention of migraines, such as botulinum toxin and newer antiepdeptic drugs, have unique mechanisms of action, presumably umelated to 5-HT. 

Krymchantowski AV, da Cunha Jevoux C, Bigal ME. Topiramate plus nortriptyline in the preventive treatment of migraine a controlled study for nonresponders. J Headache Pain January 2012 13(l) 53-9. 

These dm are primarily used in the treatment of hypertension (see the Summary Drug Table Adrenergic Blocking Drugs also see Chap. 39) and certain cardiac arrhythmias (abnormal rhythm of the heart), such as ventricular arrhythmias or supraventricular tachycardia They are used to prevent reinfarction in patients with a recent myocardial infarction (1—4 weeks after MI). Some of these dm have additional uses, such as the use of propranolol for migraine headaches and nadolol for angina pectoris. 

Intal, Nasalcrom Prophylaxis of severe bronchial asthma prevention of exercise-induced asthma (BA) Nasal preparations prevention and treatment of allergic rhinitis Dizziness, headache, nausea, dry and irritated throat, rash, joint swelling and pain... 

Recommend appropriate nonpharmacologic measures for headache treatment and prevention. 

Recommend appropriate pharmacologic treatment for prevention of future headaches. 

Divalproex sodium is comprised of sodium valproate and valproic acid. The delayed-release and extended-release formulations are converted in the small intestine into valproic add, which is the systemically absorbed form. It was developed as an antiepileptic drug, but also has efficacy for mood stabilization and migraine headaches. It is FDA-approved for the treatment of the manic phase of bipolar disorder. It is generally equal in efficacy to lithium and some other drugs for bipolar mania. It has particular utility in bipolar disorder patients with rapid cycling, mixed mood features, and substance abuse comorbidity. Although not FDA-approved for relapse prevention, studies support this use, and it is widely prescribed for maintenance therapy. Divalproex can be used as monotherapy or in combination with lithium or an antipsychotic drug.31... 

Consequently, a 4-week, medication-free period is recommended after each 6-month treatment period. Dosage should be tapered over 1 week to prevent rebound headaches. 

They may be used intermittently to prevent headaches that recur in a predictable pattern (e.g., menstrual migraine). Treatment should be initiated 1 to 2 days before the time of headache vulnerability and continued until vulnerability is passed. 

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