Week 4 notes 11 - T reatment of Migraines The migraine...

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Treatment of Migraines The migraine syndrome is complex and incompletely understood. Part of the pathophysiology seems to center around a vasoconstrictive component and a vasodilatation component. Because of these seemingly unrelated events, the best treatment for migraine is yet to be developed. No one drug or drug category will suffice to treat all patients with migraine because there are probably many different forms of migraine. Pain medication alone may not be the answer for every patient. Treatment options are categorized below as abortive therapy for an established migraine and mention is made of drugs used as prophylactic therapy. Abortive Therapy of Migraine NSAID Drugs Acetaminophen Combination Drug (Fiorinal) Serotonin Agonists Adjunctive Drugs List of NSAID Drugs Used for Migraine aspirin ibuprofen (Motrin) (Advil) etc. naproxen (Naprosyn) (Aleve) ketorolac (Toradol) flurbiprofen (Ansaid) [Note: These are the most commonly mentioned NSAID drugs for migraine but others have probably been tried with varying degrees of success.] Pharmacodynamics of the NSAID Drugs Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the cyclooxygenase (COX) enzymes. Today, the COX enzymes are recognized in two forms; COX-1 and COX- 2. The COX-1 enzyme is a normally functioning enzyme that continually synthesizes the normal biomediators prostaglandin, prostacyclin, and thromboxane. These biomediators have normal functions such as gastric mucus production, enhancement of platelet function in blood clotting, vasodilatation (especially of renal arteries), regulation of body temperature, and stimulation of uterine contractions. The COX-2 enzyme only functions during stress or inflammatory conditions and produces the same biomediators but in greater amounts to activate pain sensors, produce vasodilatation, and enhance blood clotting in damaged blood vessels. Most NSAID drugs are classified as non-selective inhibitors of the COX (cyclooxygenase) enzymes. As such, they block both of the forms of the COX enzyme and prevent the inflammatory and the normal production of the biomediators. In doing so, they decrease inflammation and the pain but also the 1
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Treatment of Migraines byproducts and the functions of the normal prostaglandins, prostacyclins, and thromboxanes. Although these are well-recognized mechanisms for these drugs, the exact way in which these actions reduce the pain of migraine remains unclear. Pharmacokinetics of the NSAID Drugs Both the salicylate and the non-salicylate NSAIDs are absorbed after oral administration. They are metabolized in the liver and excreted in the urine. To date, one (i.e., ketorolac [Toradol]) is administered I.M. and I.V. also. Advantages of the NSAID Drugs in the Treatment of Migraine - Available orally; an advantage in those patients who do not have nausea as part of their migraine syndrome. - Rapid onset of action (if they work at all)
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Week 4 notes 11 - T reatment of Migraines The migraine...

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