MIGRAINE MANAGEMENT Non pharmacological treatment Identification of triggers

Migraine management non pharmacological treatment

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MIGRAINE MANAGEMENT Non-pharmacological treatment Identification of triggers Meditation Relaxation training Psychotherapy ALM TRIP*
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MIGRAINE MANAGEMENT Pharmacological treatment Non Specific Analgesics/combination analgesics NSAIDs Opioids Neuroleptics/ Anti-emetics Migraine specific Triptans Ergotamines ALM TRIP*
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Triptans Available for Migraine Almotriptan Tablets Naratriptan Tablets Rizatriptan Tablets Orally disintegrating tablets Sumatriptan Subcutaneous Nasal spray Tablets Zolmitriptan Tablets Orally disintegrating tablets
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Triptan Pharmacology T max (h) Biologic Cranio- CNS Penetration t 1/2 Before During Activity vascular PGP Drug (h) Attack Attack (%) Selectivity Lipophilicity Substrate Almotriptan 3.5 1.5-3 ? 70 ? Yes Eletriptan 4 1 2.8 50 Yes Frovatriptan 25 3 3 30 ? (Low) ? Naratriptan 6 2-3 3-4 70 Yes Rizatriptan 2 1-1.5 1-1.5 42 Yes Sumatriptan 2 2 2.5 15 Minimal No Zolmitriptan 3 2 2.5 40 No
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MAO Inhibitors Cimetidine* Propranolol Erythromycin Almotriptan ? Eletriptan Frovatriptan ? Naratriptan Rizatriptan Sumatriptan Zolmitriptan Amerge ® , Imitrex ® , Maxalt ® , and Zomig ® package inserts. * The half-life and AUC of Zolmitriptan and its active metabolites are approximately doubled following administration of cimetidine. Rizatriptan 5 mg should be used in patients taking propranolol, as propranolol has been shown to increase the plasma concentrations of Rizatriptan by 70%. Reported thus far in Eletriptan clinical studies. Triptan Drug Interactions
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Drug Dose (mg)/d Route Domperidone 10-80 mg Oral Metoclopramide 5-10 mg Oral/IV Promethazine 50-125 mg Oral/IM Chlorpromazine 10-25 mg Oral/IV ANTI-NAUSEANT DRUGS FOR MIGRAINE TREATMENT
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WHY THE NEED FOR PROPHYLAXIS ? Abortive drugs should not be used more than 2-3 times a week Long-term prophylaxis improves quality of life by reducing frequency and severity of attacks 80% of migraineurs may require prophylaxis
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WHEN IS PROPHYLAXIS INDICATED? According to the US Headache Consortium Guidelines, indications for preventive treatment include: Patients who have very frequent headaches (more than 2 per week) Attack duration is > 48 hours Headache severity is extreme Migraine attacks are accompanied by prolonged aura Unacceptable adverse effects occur with acute migraine treatment Contraindication to acute treatment Migraine substantially interferes with the patient’s daily routine, despite acute treatment Special circumstances such as hemiplegic migraine or attacks with a risk of permanent neurologic injury Patient preference
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Drugs Dose (mg/d) 1. Betablockers Propranolol 40-320 2.
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