Migraine, caffeine treatment

Destmction of the aluminum complex with ammonia then permits hydrocarbon extraction of the alkaloid. The alkaloid is subsequently both isolated and used as its tartrate salt. This nonnarcotic dmg, for which tolerance may develop, is frequently used orally with caffeine (16) for treatment of migraine it acts to constrict cerebral blood vessels, thus reducing blood flow to the brain. 

Xanthines (usually caffeine) are frequently combined with aspirin in the treatment of headaches. In combination with an ergot derivative, methylxanthines have been used to treat migraine. These effects are likely due to their ability to produce vasoconstriction of cerebral blood vessels. Aminophylline is useful in the rehef of pain due to acute biliary colic. 

Fixed dose combinations of crude ergot preparations except those containing ergotamine, caffeine, analgesics, antihistamines for the treatment of migraine, headache. 

Lysergic acid is a well known component especially as its amide derviative - lysergic acid diethyl amide (LSD) - to be considered in the next section on CNS drugs. Today ergotamine can be used in the treatment of chronic migraine headache although its side effects do not make it an appropriate prophylactic. It is usually compounded with caffeine and administered orally, by inhalation or suppository. The caffeine increases oral and rectal absorption of the ergotamine. Oral dose is 2 mg at onset and 2 mg at 30 minute intervals up to 6 mg with no more than 10 mg administered per week. 

A 41-year-old woman presented with pain and pallor in the leg and a sensation of coolness exacerbated by exercise (34). For many years she had been taking a formulation containing ergotamine 1 mg plus caffeine 100 mg, at a dose of one or two tablets daily, for both prophylaxis and treatment of migraine. For 7 days she had also taken clarithromycin (dose is not stated) for a chest infection. Her legs were cool and cyanosed, with no palpable popliteal or foot pulses and an ankle-brachial index of only 0.6 (normal >0.8). 

Caffeine modestly increases the bioavailability, rate of absorption and plasma levels of aspirin. Adding caffeine to diclofenac may improve its efficacy in the treatment of migraine. 

A small proportion of caffeine finds application in pharmaceuticals for the treatment of migraine, pain and fever. It is occasionally administered in combination with analgesics, since caffeine augments their activity. The cosmetics industry uses caffeine as a blood-circulation-enhancing agent for skin preparations. Caffeine is needed for the production of copier paper ( Diazopaper ). The lion s share however accounts for sodas and energy drinks (Coca-Cola , PepsiCola , Red BulP), but also a host of other caffeinated food products, which has already attracted the FDA s attention. 

A 27-year-old woman was diagnosed with cervico-cerebral vasospasm and stroke after treatment with IV caffeine and ergotamine for status migraines. On hospital admission, she demonstrated a fluctuating level of consciousness and orientation with asymmetric spastic quadriparesis [33 ]. 

Caffeine decreases peripheral resistance by direct vasodilatation and increases blood flow to a small extent. This effect results from the relaxation of smooth muscle of blood vessels. For coronary arteries, vasodilatation is also observed in vitro, but the effects of caffeine in human coronary arteries in vivo are unknown. Different effects of caffeine on circulation can be observed in different vascular beds and, for example, the treatment of migraine headaches by caffeine is mediated through the vasoconstriction of cerebral arteries. It has also been shown that caffeine is capable of attenuating postprandial hypotension in patients with autonomic failure. 

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