Classification Of Migraine Drugs
There are two group of Medication /s Which are,
Ergotamine is one of the best Migraine Medication and It is an alkaloid obtained from a fungus known as cleviceps purpurea.This Fungus infest the rye and some other grains and grasses.
It is given orally,sublingually,inhalationaly,by rectal route and by intramuscular injection.When given orally it is absorb from the intestine and its absorption is variable.After metabolism the drugs is excreted in urine.Caffeine increases its absorption from the intestine.
Nausea ,vomiting and diarrhea are the most common adverse effects.
Large doses can cause spasm of the blood vessels of the arms and legs thatmay lead to their gangrene.Rarely gangrene of intestine can occur due to spasm of mesentric artieries.
Perilheral vascular disease such as Reynaud disease and buerger disease.in these disease arteries of the limb are narrowed .
Ischemic heart disease
Its better to avoid in pregnant women though there is no evidence of harmful effects.
These are a group of drugs that are recently being most commonly used in acute attack of migraine.Their mechanism of action appears to be similar to that of ergot alkaloids.
It is a 5HT1B and 5HT1D agonist and it is a great Migraine Medication which is effective in both migraine headache and cluster headache.its effectivenessin these conditions is equal to or more than that of ergot alkaloids.
When given orally only 15% of sumitriptan is absorbed into the systemic circulation.its plasma half life is two to three hours.it can be used orally,subcutaneously and as a nasal spray.
Sumitriptan is well tolerated .it can cause mild degree of abnormal sensation such as dizziness,muscle weakness,tingling,pain in the chest ,pain in the neck and pain at the site of injection.
As it is short acting several doses of drug maybe need during a prolonged attack of migraine.However no more than two doses should be given per day.
It is also a 5HT1B and 5HT1D agonist.
Use 2.5mg of naratriptan orally after an attack of migraine .
When used orally 40-70% of drug is absorbed from the intestine into systemic circulation.
If migraine recurs then 2.5mg can be used again after 4 hours of intial dose.
If the patient doesn’t respond to the first dose don’t use it again for the same attack.
A maximum of 5mg can be used per day.
Not recommended for patient below 18 year of age.
Plasma half life is about 6 hours
Mechanism and adverse reactions are similar to that of sumitriptan.
This drug is also a 5HT1B and 5HT1D agonist and is also a best Migraine Medication .
Mechanism and adverse effect are similar to that of sumatriptan.
when used orally 40-70% absorbed from the small intestine into the systemic circulation.
10mg can be used orally at the onset of an attack and if the migraine recurs then a second dose can be given after 2 hours of the first dose.
Keep that mind if the patient doesn’t respond to first dose then second dose is not used.
Maximum daily dose is 20mg and it is not recommended for children below 18 years.
Daily recommended Dose is 25 mg.
It is used in a dose of 12.5mg orally as soon as possible after the onset of migraine attack.
For recurrence of migraine a second dose should not be given before 2 hours of the first dose.
If there is no response to the first dose,second dose is not given for the same attack .
It is not recommended in children below 18 years.
It is used in a dose of 40mg orally as soon as possible after the onset of attack and repeated after 2 hours if recurs.
A second dose is not used if there is no response to the first dose.
Almotriptan is contraindicated in severe hypertension.
All of 5HT1 Agonist are contraindicated in agina pectoris,because they produce spasm of coronary arteries.
Zolmitriptan is contraindicated in wolf-parkinson-white syndrome.
Sumatriptan,rizatriptan,almotriptan,eletriptan,and zolmitriptan are short acting drugs and therefore several doses of these drugs are required during a prolonged attack.
Noratriptan and almotriptan are contraindicated in severe hepatic and renal diseases and in peripheral vascular diseases.
All NSAIDs can be used as a Migraine Medications in the treatment of acute attack of migraine.
Opioids may be used in severe cases of migraine not responding to other drugs.As they cause addiction ,care should be taken during their use.
Following are the important Medication /s that can be used in the prevention of migraine.
Drugs Prophylactic Dose
Aspirin 300mg twice daily
Prpranolol 80-240mg/Day in 3-4 doses
Imipramine 10-150mg daily in single dose
Amitriptyline 10-150mg daily in single dose
Fluoxetine 20-60mg in a single dose
Sertraline 50-200mg in a single dose
Clonidine 0.2-0.6mg daily
Mrthylsergide maleate 4-8 mg daily
Verapamil 80-160mg daily
Ergonovine maleate 0.6-2mg daily
Cyprophetadine 12-20mg daily.
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