management and drug therapy for migrain

1. Migrain
Prepared by : Arshad Ibrahim
Nanded Pharmacy College

2. Serial.
no.
Content
1 Introduction
2 Cause
3 Types
4 Phases
5 Management

3. What is migraine?
• Disorder characterized by recurrent attacks of headache
variable in intensity, frequency and duration.
• Attacks are unilateral and are usually associated with
anorexia, nausea and vomiting.
• Often only one side of the head hurts

5. Difference between migraine and tension type
headache:

6. Causes of migraine
• Potential migraine triggering factors include
1. Allergies and allergic reactions
2. Bright lights, loud noises and certain odour
1. Physical or emotional stress

7. • Irregular sleep
• Smoking

8. Burden Of Migraine
• Worlds 15-20% of women and 10-15% of men suffer from migrain
• In India, 15-20% of people suffer from migraine
• In childhood migraine, boys and girls are affected equally until puberty, when
the predominance shifts to girls
• Adult – Female : Male ratio is 2:1
• Prevalence peaks in the 25-55 age group

9. Types of migraine
According to Headache Classification Committee of the International Headache
Society, Migraine has been classified as:
• Migraine without aura – 70%
• Migraine with aura – 25%
• Migraine variants and complicated migraine – 5%

10. Difference between types
• Migraine Without Aura:
1. No focal neurological disturbance precedes the episodes of headache
2. Unilateral throbbing headache may be accompanied by nausea and vomiting
3. During headache, patient complains of phonophobia and photophobia
4. Each episode lasts for 4-72 hour
• Migraine With Aura:
1. Hallucination may present, limb weakness may observe
2. Unilateral throbbing headache and later becomes genralised
3. Patient complains of visual disturbances and may have mood variations
4. Episode lasts for 10-30 min

11. Phases of Migraine
1. Prodrome
2. Aura
3. Headache
4. Postdrome

12. PRODROME
• Vague premonitory symptoms that begin from 12 to 36 hours before the aura
and headache
• Symptoms include
1. Yawning
2. Excitation
3. Depression
4. Lethargy
• Duration – 15 to 20 minutes

13. Aura
• Aura is a warning or signal before onset of headache
• Symptoms
1. Flashing of lights
2. Zig-zag lines
3. Difficulty in focussing
• Duration : 15-30 min

14. Headache
• Headache is generally unilateral and is associated with symptoms like:
1. Anorexia
2. Nausea
3. Vomiting
4. Photophobia
5. Phonophobia
• Duration : 4-72 hrs

15. Postdrome (Resolution Phase)
• Following headache, patient complains of
1. Fatigue
2. Depression
3. Severe exhaustion
4. Some patients feel unusually fresh
• Duration : Few hours or up to 2 days

17. Migraine - pathophysiology
• Vascular Theory:
It was believed that ischemia induced by intracranial vasoconstriction is
responsible for the aura of migraine and the subsequent vasodilation resulted in headache.
Based on three observations:
1. Extracranial vessels become distended and pulsatile during an attack
2. Stimulation of an intracranial vessels in an awake person induces headache
3. Vasoconstrictors improve the headache and vaso dilators provoke an attack

19. Diagnosis and Clinical Features
• Repeated attacks of headache lasting 4-72 h in patient with a normal physical examination,
and
• At least two of the following features:
1. Unilateral pain
2. Throbbing pain
3. Aggravation by movement
4. Moderate or severe intensity
• Plus at least one of the following features:
1. Nausea/vomiting
2. Photophobia and phonophobia

20. Management
• Non-pharmacological treatment:
1. Identification of triggers
2. Meditation
3. Relaxation Training
4. Psychotherapy
• Pharmacotherapy:
1. Abortive therapy
2. Preventive therapy

21. Protective Factors
• Regular sleep
• Regular meals
• Regular exercise
• Healthy lifestyle

22. Non-pharmacological Therapies
• Relaxation training
• Hypnotherapy
• Behavioral management
• Nutritional supplements
• Physical therapy and massage

23. Abortive Therapy
• Reduces headache recurrence.
• Alleviation of symptoms
• Analgesics -Tylenol, Paracetamol etc
• Antiphlogistic’s – NSAID’s like Ibuprofen
• Vasoconstrictors – Caffeine, Sympathomimetics

24. Preventive therapy
• Betablockers – propranolol
• Calcium Channel Blockers – Verapamil
• Tri -cyclic antidepressants – Amitriptyline
• Anti-convulsant – Sodium valproate
• Anti-histaminic – Cyproheptadin.

25. Resources
https://www.slideshare.net/VMMCSJH/pharmacotherapy-of-migraine
https://www.slideshare.net/tityo/migraine-treatment-ppt
http://emedicine.medscape.com/article/1142556-treatment