Migraine headaches, treatment

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

Migraine headache treatment will vary according to the symptoms and severity of headache presentation. 

Lower respiratory tract infections treatment of Macrolide antibiotics Manic symptoms drug-induced Migraine headaches treatment of Monoamine oxidase inhibitors contemporary treatment of depression Multiple sclerosis treatment of Myasthenia gravis treatment of Mycoses treatment of deep-seated organisms Myoclonus treatment of Narcolepsy treatment of Neurotransmitters and their receptor subtypes Newborns undeveloped pharmacokinetic profile Nitrate products... 

Among the indole derivatives which have found use as drugs are indo-methacin, one of the first non-steroidal anti-inflammatory agentsfll], sumatriptan, which is used in the treatment of migraine headaches[12] and pindolol[13], one of the p-adrenergic blockers. 

The aerosol container has enjoyed commercial success ia a wide variety of product categories. Insecticide aerosols were iatroduced ia the late 1940s. Additional commodities, including shave foams, hair sprays, antiperspirants, deodorants, paints, spray starch, colognes, perfumes, whipped cream, and automotive products, followed ia the 1950s. Mediciaal metered-dose aerosol products have also been developed for use ia the treatment of asthma, migraine headaches, and angiaa. 

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. 

Tension-type headache (TTH) is the most common primary headache disorder. It is often underrepresented in clinical practice, as many patients do not present for care.6 The term tension-type headache is used to describe all headache syndromes in which muscle contraction is the most significant factor in the pathogenesis of pain. The 1-year prevalence of TTH in the population ranges from 30% to 90%.6 It is more common in adult females. Environmental factors, as opposed to genetic predisposition, play a more central role in their development. Tension-type headaches can be further divided into episodic or chronic the mean frequency of attacks is 3 days per month in episodic disorders, and chronic TTH is defined as 15 or more attacks in a 1-month period.7 The estimated prevalence of chronic TTH is less than 5%.6 Some researchers believe that chronic TTHs represent a continuum of headache severity with migraine headache.8 When severe headaches are difficult to differentiate clinically, treatment should initially target TTH. 

Lewis D, Ashwal S, Hershey A, et al. Practice parameter Pharmacological treatment of migraine headache in children and adolescents. Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 2004 63 2215-2224. 

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... 

Sumatriptan succinate is effective for the treatment of acute migraine headaches by acting as... 

FIGURE 53-1. Treatment algorithm for migraine headaches. (NSAIDs, nonsteroidal... 

A treatment algorithm for migraine headache is shown in Fig. 53-1. Acute migraine therapies (Table 53-2) are most effective when administered at the onset of migraine. 

FIGURE 53-2. Treatment algorithm for prophylactic management of migraine headaches. (NSAID, nonsteroidal antiinflammatory drug.)... 

Ergotamine is an ergot alkaloid derivative indicated in the treatment of migraine. Propranolol (a fat-soluble and therefore centrally active beta-blocker) and amitriptyline (tricyclic antidepressant) are used for the prophylaxis of migraine headache. 

Phenobarbitone is used to treat epilepsy, migraine headache, dental infections, pregnancy vomiting, tetanus, enuresis, chorea, pre and post operative sedation, hypertension, anxiety states, neurosis, and in the treatment of drug and alcohol addiction. This drug is also called phenobarbital. 

S.5.5.2.3 Historical controls Since many clinical trials are conducted in the same diseases, with the same control treatments there is an obvious desire to make the most use of this potentially valuable information. Can we compare the results of a new treatment in a group of patients with a group of control patients extracted from a historical database For example, suppose we are testing a new treatment for migraine headache and 60% of patients improve in the first 2 h post-treatment, compared to 30% in a group of historical control patients treated who had been treated with the current gold standard. Are we able to conclude that the new treatment is preferable to the gold standard ... 

Dihydroergotamine For the acute treatment of migraine headaches with or without aura and the acute treatment of cluster headache episodes (injection only). Dihydroergotamine nasal spray is not intended for the prophylactic therapy of migraine or for the management of hemiplegic or basilar migraine. 

Based on a review of this drug (isometheptene mucate) by the National Academy of Sciences-National Research Council or other information, FDA has classified the other indication as possibly effective in the treatment of migraine headache. Final classification of the less-than-effective indication requires further investigation. 

All the drugs used for migraine headache are aimed at symptom relief and not against the yet unrecognized cause. Two observations are however most striking first the impact on the concept of pain (for example see analgesics in the chapter on the treatment of pain) and secondly the fact that the pathophysiological principles are poorly defined. 

At least three studies have demonstrated that feverfew (dried leaf, not extract) can reduce the frequency and severity of migraine headaches, although one study failed to find any significant difference from placebo. Prophylaxis appears to be more effective than acute treatment. There is also a consensus that feverfew is probably less effective than conventional migraine prophylaxis, although it may have a role as a second-line option. Although feverfew has also been used for rheumatism, it has never been verified to be effective in clinical trials. 

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

Alternative to sumatriptan for the treatment of migraine headache has not been compared head-to-head with sumatriptan choice should be based on cost and availability... 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

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