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Anti-Migraine Drugs
Anti-Migraine Drugs
Anti-Migraine Drugs
By
Dr. shahid Ali
Overview
• Headache
– Pain usually dispersed throughout head
• Migraine
– Pain concentrated on one side of head
What causes these symptoms?
• Exact mechanism still not
known
• Not initiated by blood vessel
problems
– This is secondary
• Cortical spreading depression
– Inflammatory mediators
irritate cranial nerves,
especially the trigeminal
nerve
Where does the headache come
from? • When a headache
occurs, serotonin and
magnesium levels drop
– Trigeminal nerve
releases
neuropeptides
– Neuropeptides travel
to outer covering of
the brain and cause
dilation and
inflammation of
meningeal blood
vessels
• Dura and dura vessels
disrupted but brain
structure remains intact
– No increased risk of
a brain tumor
Causes
• Mechanism still debated
• Common triggers
– Hormonal: Estrogen and
Progesterone
– Foods: alcohol, chocolate,
etc.
– Stress, physical activity,
sleep
– Environmental stimulus:
sight, smells
– medications
Treatments of the Past
• Migraines have been have
a medical history of 9000
years
– First mode of
treatment: trepanation
• Galen of Pergamum
was an ancient Greek
physician in the 2nd
century AD
– Used the term
“hemicrania” for which
he thought the brain
and stomach were
connected
– “Migraine” evolved
from this term
Treatments of the Past…
• Non-specific
– Aspirin, NSAIDs
• Ergots
• 5-hydroxytryptamine (5-HT) agonists
– Sumatriptan (imitrex)
– Zolmitriptan
– Naratriptan
– Rizatriptan
Aspirin
Vs.
Serotonin
Rizatriptan
Eletriptan
Zolmitriptan
Migraine Drugs of the Future
• Botox
– Immediate relief and migraine
prophylaxis/prevention
• Administration of magnesium
• Patent foramen ovale surgery
– Evidence that when hole between
upper chambers of the heart is
patched, migraines are relieved
Thank you!