3 - Drugs 101 Headache Cephalalgia enjoyed by 90 of...

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Unformatted text preview: Drugs 101 Headache Cephalalgia enjoyed by 90 % of population Once believed headaches caused by demons Lose the demon to lose the headache Metallic tractor pulls out the pain Surgical cures for headaches Trepanation as a cure for headache Specialty tools for trepanation Trepanation is for life Modern practitioners of trepanation Brain does not feel pain Pain in thin tissue surrounding skull Understand the headache before treating • 12 types of headache – 60 sub-types • Headaches grouped into 2 classes – Muscular – Vascular Muscular headache - muscle band around skull Muscular headache caused by stress Treat muscular headache • • • • A.S.A. Acetaminophen Ibuprofen Naproxen Vascular headache involves blood circulation • 3 major types – Toxic – Migraine – Cluster Toxic headache caused by poison Pain is caused by vasodilation Most common type of toxic headache Metabolism of alcohol contributes or helps ethyl alcohol alcohol dehydrogenase acetaldehyde acetaldehyde dehydrogenase acetic acid Aging adds to the pain Presence of congeners increases severity Vodka 1 Gin 1 White wine 4 Beer 4.5 Whiskey 4.5 Sherry 4.5 Rum 7.5 Red wine 9 Whisky 10 Cognac 10 Alcohol increases liver function Liver makes acetaminophen toxic • Don’t take acetaminophen for hangover acetaminophen Glucuronyl transferase removal from body Cytochrome P450 toxic metabolite Liver Damage Some red wines contain histamine Some fermented foods contain histamine Some aged cheeses contain tyramine Chocolate triggers some headaches Hotdogs contain nitrites Nitroglycerin is a potent vasodilator Monosodium glutamate MSG Kikunae Ikeda 1907 Kwok syndrome and MSG MSG in Oriental cooking Some people avoided MSG Millions spent researching potential effects MSG does NOT cause headaches MSG is in virtually all prepared food Disguised as hydrolyzed vegetable protein MSG is a normal human metabolite • Constitutes approximately 5% of our protein • Produced constantly in the body Caffeine gives rebound vasodilation Brain freeze Treat toxic headache • A.S.A. • Ibuprofen • Naproxen Acetaminophen and toxic headaches • Increased liver function causes acetaminophen toxicity – Liver damage • Don’t take acetaminophen for hangover Caffeine may help reduce the pain Migraine is an over used term Migraine affects smaller % of population • 18 % of women get migraines • 6 % of men get migraines Migraine headache is two stage process • Phase 1 : Vasoconstriction Migraine headache is two stage process • Phase 2 : Vasodilation Migraine initiated by a trigger • • • • Tension Lack of sleep Menstruation Foods • • • • • Relaxation Too much sleep Pregnancy Drugs Strong smells Migraine headaches follow a progression • • • • Prodrome phase Aura Pain Postdrome Prodrome phase gives a warning • 30 to 40 % of sufferers • Mood swings Aura phase in 20 to 30 % of sufferers • One or two hours before pain phase • Scotomas – Visual disturbances, flashes of light • • • • • Olfactory hallucinations Auditory hallucinations Vertigo Reduced sensation Hypersensitivity Pain involves half of the head • • • • • • Hemicrania (Latin) Hemigrania (French) Lasts 1 to 72 hours Nausea is common GI disturbances Movement makes it worse Sensitivity to light, sound, smell Postdrome phase may take hours or days • • • • “Hung over” Exhaustion Poor concentration Depression or euphoria Treatment – pain meds and ride it out • • • • • A.S.A Acetaminophen Ibuprofen Naproxen Prescription pain meds Triptans can abort a migraine Rye bread common in medieval Europe Ergot is a fungus that grows on rye St. Anthony’s fire from vasoconstriction Gangrene requires amputation Midwives used ergot to induce labor Ergot is a powerful hallucinogen Ergot poisoning seen as demonic possession Inquisition in Europe Normal law was suspended for witches No-win for witches Witchcraft in Salem 1692 Witch hunt in Canada Kira Canhoto killed during exorcism 1995 Witchcraft killing in London Extracts of ergot for migraine 1862 Arthur Stoll isolates ergotamine in 1918 Cafergot still available today Ergotamine is not drug-like N Ergotamine • Prevents migraine • Poison in high doses OH O N O O O N H N – – – – – NH • Drug-like substance • Provides beneficial effect – Specific • Limited side effects – Low incidence – Low severity • Cheap to manufacture • Patentable Hallucinations Muscular contractions Vasoconstriction Gangrene Death Albert Hoffman discovers LSD by accident The bicycle day LSD was used by the CIA at McGill in 1950’s Hallucinations from part of ergotamine N N OH O O O O N N O NH LSD (illegal drug) Hallucinations N H N NH Ergotamine (poison) Stops migraine Hallucinations Muscular spasms Gangrene Death Migraine starts with serotonin Serotonin levels change during migraine • Amounts drop during aura – Prevent migraine by replacing missing serotonin with a drug NH2 HO N H Nerve signals are chemical Nerve signals are cascading chemical reactions Nerve cells do not touch each other Messages carried by neurotransmitters Use a drug that works like serotonin Serotonin is a poor drug • Used in many parts of the brain – Drug must only affect migraine • Does not easily pass from blood to brain – Drug must travel from stomach to brain in the blood Basis for serotonin drug selectivity Serotonin fits into receptors Serotonin fits other receptors Engineer for the effect you want N N OH O O O O N N O N H N NH2 HO NH NH LSD (drug) Hallucinations Ergotamine (poison) Stops migraine Hallucinations Muscular spasms Gangrene Death N H Serotonin (neurotransmitter) reduced amounts trigger migraine Sumatriptan selectively targets migraine NH2 N H N HO O2 S N H serotonin N H sumatriptan First triptan drug for migraine Magic potion for migraine Many options for migraine • • • • • • Sumatriptan Rizatriptan Naratriptan Zolmitriptan Eletriptan Almotriptan Lots of causes of headache Treat with painkiller Gain added benefit from understanding ...
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  • Spring '12
  • Ogilvie
  • Headaches, Paracetamol, Non-steroidal anti-inflammatory drug, migraine, migraine headache, toxic headache

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