Migrainous infarction

Migrainous infarction (aura symptoms associated with an ischemic brain lesion)... 

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. 

Introduction of )3-adrenoblockers into medicine was one of the main advancements of pharmacology of the cardiovascular system. Initially these drags were used only in treating essential hypertension. Currently, they are used in treating angina, arrhythmia, migraines, myocardial infarctions, and glaucoma. 

Propranolol is used in treating arterial hypertonicity, angina, extrasystole, superventric-ular arrhythmia, ventricular tachycardia, migraines, hypertrophic subaortic stenosis, and pheochromocytoma. It also is used in the postanginal phase of myocardial infarctions. Universally accepted synonyms of this drug are anaprilin, inderal, and many others. 

Use 5-HTi agonists only where a clear diagnosis of migraine has been established. Risk of myocardial ischemia or infarction and other adverse cardiac events Because of the potential of this class of compounds to cause coronary vasospasm, do not give these agents to patients with documented ischemic or vasospastic coronary artery disease (CAD). 

These potential benefits are balanced by a slightly increased risk of gallbladder disease, hypertension, myocardial infarction, cerebral infarction, and pulmonary embolism. The increased risk of stroke and heart attack associated with the pill is accentuated when compounded by other risk factors, including smoking, migraine headaches, and advancing age. Indeed, convincing data support an upper age limit of 35 years for oral contraceptive use by women who smoke. 

Sanchez-Guerra M, Valle N, Blanco LA, Combarros O, Pascual J. Brain infarction after postcoital contraception in a migraine patient. J Neurol 2002 249 774. 

Hypertensive patients with concomitant diseases The (3-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, glaucoma (applied topically), and migraine headache. 

The major clinical uses of atenolol include hypertension angina pectoris acute myocardial infarction (MI) heart rhythm disturbances and migraine prophylaxis. In hypertonia disease, various studies have addressed the efficacy of atenolol in... 

Sometimes arterial occlusion is demonstrated by angiography in migrainous stroke and the cause is hypothesized to be in-situ thrombosis complicating vasospasm. No provoking factors are known. Other possible causes of stroke in the context of headache must be considered carotid dissection, mitochondrial cytopathy, ruptured vascular malformation, antiphospholipid antibody syndrome and CADASIL (cerebral autosomal dominant arterio-pathy with subcortical infarcts and leukoencephalopathy). Migraine auras without headache may be confused with TIA (Ch. 8). 

Hoekstra-van Dalen RAH, Cillessen JPM, Kappelle LJ et al. (1996). Cerebral infarcts associated with migraine clinical features, risk factors and follow up. Journal of Neurology 243 511-515... 

Pradalier A, Lutz G, Vincent D. Transient global amnesia, migraine, thalamic infarct, dihydroergotamine, and sumatriptan. Headache 2000 40(4) 324-7. 

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