Antimigraine drugs 2010Bb - ANTIMIGRAINE DRUGS 1 Examine...

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ANTIMIGRAINE DRUGS
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1. Examine Migraine Physiology A. Stages of Migraine B. C. Examine Migraine Triggers 2. Targets of Migraine Drug Therapy 3. Treatment: A. DA ANT B. Non-specific: NSAIDS, antihistamines C. Opiates D. Lidocaine E. Ergotamine F. Triptans 4. Prevention: A. CV drugs B. Antidepressants C. Antiseizure D. Cannabis Learning Objectives
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1. What is a Migraine? A DEBILITATING HEADACHE DISORDER Recurring (5 or more attacks of greater than 4 hrs duration) affects only one side of the head (unilateral) often pounding (pulsating) may be accompanied by decreased appetite, nausea, vomiting and intolerance to light (photophobia) and sound (phonophobia) decreases in incidence with age Lasts 4-72 hrs two categories 80% = common migraine (without aura) 20% = classic migraine (with aura)
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CLASSIC MIGRAINE (with aura) Second most common of the migraine headaches Suffers can also have migraine without aura Cortical Spreading Depression (CSD) Wave of excitability that travels across cortex starts with visual disturbances (aura): bright dots flashes of light zig-zag lines Temporary loss of vision Symptoms can last 5- 60 minutes
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COMMON MIGRAINE (without aura) Most common No discernable visual or auditory premonitions. Suffers can also have migraine with aura
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SYMPTOMS OF MIGRAINE Head pain pounding, pulsating, throbbing Nausea/vomiting Loss of appetite Light or sound sensitivity Scalp tenderness Dizziness and lightheadedness Double vision Blind spots Irritability
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1A. The Stages of a Migraine Attack
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PRODROME Feelings of elation and intense energy Craving for sweets Thirst Irritability Feelings of depression Drowsiness blogs.mysanantonio.com
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Mehrotra et al., 2008
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AURA: Stage 1 Arteries vasoconstriction Some of the brain may not get a sufficient supply of blood in this phase Ischemia Cortical Spreading Depression (CSD) Brain tissue that is not getting enough blood reacts by being more active electrically leading to visions or distortions Probably serotonin related Can occur before any headache
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Stage 2 Vasodilation with concomitant stimulation of trigeminal nerve (TGN) endings in the vessel walls that release neuropeptides produce swelling and sends pain signals to pain centres As migraine symptoms worsen, 5-HT levels decrease. Intracranial
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This note was uploaded on 12/03/2010 for the course PHAMACOLOG pcl470 taught by Professor Arnot during the Fall '10 term at University of Toronto.

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Antimigraine drugs 2010Bb - ANTIMIGRAINE DRUGS 1 Examine...

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