Migraine syndrome

Unlike skeletal muscles, which contain endogenons stores of calcium ions, both cardiac muscle and vascnlar smooth muscle require extracellular calcium for contractile function. Therefore, cardiac muscle and vascnlar smooth muscle are subject to regulation by calcium antagonists or calcium entry blockers (Figure 103 and Table 21), which are used in the treatment of hypertension, Raynand s disease, Prinzmetal s angina, and migraine syndromes. 

Roffman RA, Barnhart R Assessing need for marijuana dependence treatment through an anonymous telephone interview. Int J Addict 22 639-631, 1987 Russo EB Clinical endocannabinoid deficiency (CECD) can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions Neuro Endocrinol Lett 25(1-2) 31—39, 2004... 

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. 

Cluster headache disorders are the most uncommon and severe primary headache syndromes.9 The estimated point prevalence is less than 1%. Unlike migraine and TTH, cluster headaches occur more frequently in men. Onset commonly occurs prior to age 30.6 A genetic predisposition seems apparent, although affected individuals often provide a history of tobacco use and alcohol abuse.6 Attacks consist of debilitating, unilateral head pains that occur in series lasting up to months at a time, but that remit over months to years between occurrences. In rare instances, cluster headache can be a chronic disorder without remissions.4... 

Features of central sensitization are pain in response to normally innocuous tactile stimuli, and the spread of pain sensitivity beyond the site of tissue injury. Central sensitization plays a major role in acute post-traumatic pain, and also in migraine, neuropathic pain (see below) and some diffuse chronic pain syndromes, such as fibromyalgia and irritable bowel syndrome. In these conditions, which have no detectable peripheral trigger, an autonomous central sensitization may be the pathology, increasing the gain in neuronal activity in the CNS and thereby producing abnormal responses to normal inputs. 

Kozma, C. M., Barghout, V., Slaton, T., Freeh, F., and Reeder, C.E. (2002) A comparison of office-based physician visits for irritable bowel syndrome and for migraine and asthma. Manag. Care Interface. 15, 40-43, 49. 

Any migraine sufferer will willingly testify that this condition has little in common with the headaches to which the rest of mankind are subject. Recent medical studies too have shown fairly conclusively that, whatever the etiology of migraine, it is a condition quite distinct from the common headache. The syndrome is in fact so distinct as to be untouchable by the common headache cures such as aspirin. Drugs for treatment of migraine are unfortunately almost nonexistent. (The lack of appropriate animal models in no small way hinders the search for a treatment.) A... 

Drugs that block j32-receptors generally have a calming effect and are prescribed for anxiety, migraine, esophageal varices, and alcohol withdrawal syndrome, among others. 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

There are various neurologic disorders which can be treated with jS-blockers like migraine, certain forms of tremor and alcohol withdrawal syndrome. Somatic manifestations of anxiety respond well to /3-adrenoceptor blockade. jS-Blockers with a selectivity for the jSi-subtype might be useful to avoid extracardial side effects. 

Unlabeled Uses Acute alcohol withdrawal, arrhythmia (especially supraventricular and ventricular tachycardia), improved survival in diabetics with heart disease, mild to moderately severe CHF (adjunct) prevention of migraine, thyrotoxicosis, tremors treatment of hypertrophic cardiomyopathy, pheochromocytoma, and syndrome of mitral valve prolapse... 

---