Migraine headaches preventive treatment

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. 

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. 

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... 

Unlabeled Uses Diagnosis of pheochromocytoma, opioid withdrawal, prevention of migraine headaches, treatment of diarrhea in diabetes mellitus, menopausal flushing... 

Unlabeled Uses Treatment of neurogenic pain, panic disorder prevention of migraine headache... 

Propranolol reduces the frequency and intensity of migraine headache. Other 13-receptor antagonists with preventive efficacy include metoprolol and probably also atenolol, timolol, and nadolol. The mechanism is not known. Since sympathetic activity may enhance skeletal muscle tremor, it is not surprising that 13 antagonists have been found to reduce certain tremors (see Chapter 28). The somatic manifestations of anxiety may respond dramatically to low doses of propranolol, particularly when taken prophylactically. For example, benefit has been found in musicians with performance anxiety ("stage fright"). Propranolol may contribute to the symptomatic treatment of alcohol withdrawal in some patients. 

Sir William Brooke O Shaughnessy introduced Indian hemp to the West in 1839. William Brooke O Shaughnessy entered the service of the East India Company in 1833 as assistant surgeon. He studied the botany and chemistry of herbs used in oriental medicine and incorporated some into his edition of the Bengal Pharmacopoeia published in 1842. One of these herbs was cannabis, or Indian hemp. His medical treatise recommended an extract from the plant for patients with rabies, cholera, tetanus, and infantile convulsions. Until the end of the 19th century prominent physicians of Europe and North America advocated cannabis extracts for the prevention and symptomatic treatment of migraine headache. 

The applicant has claimed that the indole and the benzothiophene can treat migraine and prevent cancer. However, the only data given in the application relate to the use of the compounds for the treatment of migraine headaches. There are no data to support the allegation that these same compounds will prevent cancer. In the absence of such data, the claimed method is simply not credible. For that reason, this claim is rejected for lack of enablement under section 112, paragraph 1. 

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... 

The use of tiagabine 4-16 mg/day in preventing migraine has been studied in 41 patients who had failed treatment with divalproex sodium because of adverse effects or lack of efficacy (4). There was at least a 50% reduction in the frequency of migraine headaches in 33 patients. There were adverse events in 12 patients, most commonly tiredness a few patients had weight gain or confusion. 

In Canada, the Health Protection branch allows sale of tablets and capsules made from feverfew crude dried leaves for decreasing the frequency and severity of migraine headaches. The products should be standardized to contain no less than 0.2% parthenolide. In France, feverfew has traditional use in the treatment of heavy menstrual flow and prevention of migraine headache (4). 

Uses propranolol, a p-adrenergic blocker, is most commonly used to reduce blood pressure treatment of over-active thyroid and some types of tremor prevention of migraine headaches and some heart-rhythm problems used to decrease the number of angina attacks (pain from an inadequate oxygen supply to the heart) used after a heart attack to prevent further damage to the heart A... 

Uses p-adrenergic blocker most commonly used to treat raised blood pressure used to treat angina (pain from inadequate oxygen supply to the heart muscle) treatment of some disturbances of heart rhythm used to prevent migraine headaches drops treat some types of glaucoma (raised pressure within the eye) A... 

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. 

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