Migraine medications

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Migraine medications

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Migraine medications

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Migraine medications

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Sumatriptan p. 567

cluster headaches p. 536

coronary vasospasm with p. 249

Transcript

Content Reviewers

Yifan Xiao, MD

Contributors

Elizabeth Nixon-Shapiro, MSMI, CMI

Victoria S. Recalde, MD

Evan Debevec-McKenney

Tanner Marshall, MS

Migraine medications include a wide variety of drugs used to treat a specific type of headache called migraine.

Migraines are the second most common primary headache.

They’re often preceded by symptoms like irritability, depression, and fatigue that can begin hours to days before the headache itself. Sometimes there can be an aura where people experience strange smells, lights, visual disturbances, or even hallucinations before the onset of the migraine.

The migraine itself usually feels like a pounding or pulsating, typically localized to one side of the head and can last from hours to days.

As if this was not bad enough, these headaches tend to come with nausea and vomiting, irritability, and pain or discomfort with lights, sounds, and smells called photophobia, phonophobia, and osmophobia, respectively.

During childhood, individuals can have nausea and vomiting without the headaches; and that’s called an abdominal migraine.

After a migraine is over, it can leave people feeling sore at the location of the pain and generally fatigued.

To remember the main features of migraines, you can use the mnemonic POUND, where P stands for pulsatile headache, O stands for one-day duration, U stands for unilateral, N for nausea, and D for disabling.

Although the underlying mechanism causing migraines isn’t well understood, there are some clues.

Concentrations of the neurotransmitter, serotonin, increase during the aura, triggering vasoconstriction, and then decrease to lower-than-normal levels during the migraine attack, triggering vasodilation. This change in the blood vessel size may be a trigger for pain receptors, causing the headache.

The initial vasoconstriction may also trigger cortical spreading depression, which is a phenomenon when the brain becomes hypersensitive to certain stimuli like lights, sounds, and smells.

Migraines are often associated with specific triggers like the smell of cigarette smoke, foods like chocolate or cheese, and drinking wine.

Sources

  1. "Katzung & Trevor's Pharmacology Examination and Board Review,12th Edition" McGraw-Hill Education / Medical (2018)
  2. "Rang and Dale's Pharmacology" Elsevier (2019)
  3. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  4. "Treatment of acute migraine headache" Am Fam Physician (2011)
  5. "Migraine Headache Prophylaxis" Am Fam Physician (2019)
  6. "Spotlight on Anti-CGRP Monoclonal Antibodies in Migraine: The Clinical Evidence to Date" Clin Pharmacol Drug Dev (2017)
  7. "Triptans and ergot alkaloids in the acute treatment of migraine: similarities and differences" Expert Review of Neurotherapeutics (2013)
  8. "The pathophysiology of migraine: implications for clinical management" Lancet Neurol (2018)
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