Migraines, treatment

Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT1BAD agonists) in acute migraine treatment A meta-analysis of 53 trials. Lancet 2001 358 1558-1575. 

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. 

Unlabeled Uses Prevention of migraine treatment of behavior disorders in Alzheimer s disease bipolar disorder chorea, myoclonic, simple partial, and tonic-clonic seizures organic brain syndrome schizophrenia status epilepticus tardive dyskinesia... 

Lamotrigine in doses up to 100 mg/kg/day was successful in migraine prophylaxis as shown in two clinical studies (D Andrea et al., 1999 Lampl et al., 1999) however, a third study did not show significant effects versus placebo (Steiner et al., 1997). Further controlled trials are warranted to further validate the effectiveness of lamotrigine in prophylactic migraine treatment. 

It is an effective antiemetic, which is a useful property in migraine treatment. 

Russo, E., Cannabis for migraine treatment the once and future prescription An historical and scientific review, Pain, 76, 3-8, 1998. 

Opiate narcotics are used to treat migraines only in extreme cases because of their addictive potential. They also appear to be less effective than some of the other attack-abortive migraine treatments, and they take longer to start working. 

Silberstein SD, Young WB, Mendizabal JE, Rothrock JF, Alam AS. Acute migraine treatment with droperidol. A randomized, double-blind, placebo-controlled trial. Neurology 2003 60 315-21. 

Anecoitave, 34 Migraine Treatment Almotriptan, 146 Alniditan, 133 Avitriptan, 146 Tidembersat, 164 Multidrug Resistance Treatment Biricodar, 119 Tariquidar, 167 Tesmilifene, 58 Zosuquidar, 79... 

As mentioned previously, one of the major benefits of nasal drug delivery is the rapid onset of action (tmax)- Migraine treatment takes advantage of this fact. Compared to the orally taken tablet, tmax is much shorter. The neurosecretory hormone melatonin, which is used widely against jetlag, shows a very impressive time profile when administered as a nasal spray. The peak levels of melatonin after nasal administration appear to be 50 times higher than after oral administration. 

The etiology of migraine headaches is currently attributed to the neurovascular hypothesis, with the release of vasoactive neuropeptides and subsequent vasodilation of blood vessels. Serotonin plays an important role in migraine pathophysiology, and serotonin agonists have an important role in migraine treatment. 

New initiatives in developing migraine treatments include the use of TACHYKININ RECEPTOR ANTAGONISTS and CALCITONIN GENE-RELATED PEPTIDE RECEPTOR ANTAGONISTS. 

Route of administration may have a significant effect on patient response. A meta-analysis of 22 acute migraine treatment trials showed greater effect associated with a... 

Migraine can often be treated with paracetamol, ibuprofen or aspirin alone, or with combination products containing them. There are also some non-prescription medicines specifically licensed for the treatment of migraine. One such is a coformulation of paracetamol, codeine and the antihistamine buclizine, included for its antiemetic action. Other specific migraine treatments are reviewed below. 

Russo E (2001) Hemp for headache an in-depth historical and scientific review of cannabis in migraine treatment. J Cannabis Ther 1 21-92... 

Avoid escalation of headache medication use Educate and enable patients to manage their disease Reduce headache-related distress and psychological symptoms Goals for Acute Migraine Treatment... 

Multiple actions including block of T-type Ca2+ channels, inhibition of GABA transaminase, and block of axonal Na channels. In addition to seizure states, it is a backup in bipolar disorders and used in migraine treatment. 

Almotriptan is a serotonin 5-HTi receptor agonist that shows selectivity for vascular serotonin (5-HT) receptor sub-type, causing vasoconstriction of cranial arteries. Almotriptan is indicated for an acute treatment of migraine with or without aura (see Migraine—Treatment of). 

Ramadan NM, Skijarevski V, Phebus LA, et al. 5-HTif receptor agonists in acute migraine treatment a hypothesis. Cephalgia 2003 23 778-785. 

Joyce DA, Gubbay SS. Arterial complications of migraine treatment with methyseigide and parenteral ergotamine. EMJ (1982) 285,260-1. 

The substitution pattern of the first example is particularly important as the neurotransmitter serotonin is an indole with a hydroxyl group in the S-position, and many important drugs follow that pattern. Sumatriptan (marketed as Imigran, the migraine treatment) is an analogue of serotonin, whose synthesis starts with the formation of a diazonium salt (Chapter 22) from the aniline shown below. Nitrosation gives the diazonium salt, and reduction with SnClj and HCl returns the salt of the phenylhydrazine. 

Dubey R, Martini LG, and Christie M. (2013). Duel-acting subcutaneous microemulsion formulation for improved migraine treatment with Zolmitriptan and Diclofenac Formulation and in vitro-in vivo characterization. AAPSJ, 16, 214-220. 

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