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MIGRAINE ANDANTIMIGRAINE DRUIGS
BY
M.SARANYA
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INTRODUCTION
Migraine is common anddebilitating condition affecting 10-15% ofpeople, Migraine is a mysterious
disorder characterized by moderate tosevere headaches, and nausea althoughthe cause is not understood. which
comes in attacks lasting 4-48 hours. It isabout three times more common inwomen than in men.
http://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Headache8/4/2019 Migraine and Anti Migraine Druigs
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Signs and symptoms
Migraine attack consist of an initial visualdisturbance (the aura), in which a flickeringpattern, followed by blind spot (a scintillatingscotoma), progresses gradually across anarea of the visual field.
The visual disturbance is followed ,about 10minutes later, by a severe throbbingheadache, starting unilaterally.
And often associated with nausea, vomiting,sensitivity to light and sound, flashes of light,vertigo, loose motions and other symptoms.
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Two major types are
Migraine without aura(common migraine) involvesmigraine headaches that are not accompanied by anaura (visual disturbance).
Migraine with aura(classical migraine )usually
involves migraine headaches accompanied by an auraor other neurological symptoms.
Two other varieties are Familial hemiplegic migraineand Sporadic hemiplegic migraine, Another variety isbasilar-type migraine, where a headache and aura areaccompanied by difficulty speaking, vertigo, ringing inears, or a number of other brainstem-relatedsymptoms, but not motor weakness.
http://en.wikipedia.org/wiki/Familial_hemiplegic_migrainehttp://en.wikipedia.org/wiki/Sporadic_hemiplegic_migrainehttp://en.wikipedia.org/wiki/Basilarhttp://en.wikipedia.org/wiki/Dysarthriahttp://en.wikipedia.org/wiki/Vertigo_%28medical%29http://en.wikipedia.org/wiki/Tinnitushttp://en.wikipedia.org/wiki/Tinnitushttp://en.wikipedia.org/wiki/Tinnitushttp://en.wikipedia.org/wiki/Tinnitushttp://en.wikipedia.org/wiki/Vertigo_%28medical%29http://en.wikipedia.org/wiki/Dysarthriahttp://en.wikipedia.org/wiki/Basilarhttp://en.wikipedia.org/wiki/Sporadic_hemiplegic_migrainehttp://en.wikipedia.org/wiki/Familial_hemiplegic_migraine8/4/2019 Migraine and Anti Migraine Druigs
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Cause and Triggers
Cause The underlying cause of migraines is unknown. There
are, however, many biological events that have beenclinically associated with migraine.
Triggers Migraines may be induced by triggers, with some
reporting it as an influence in a minority of cases andothers the majority.
Many things have been labeled as triggers, however
the strength and significance of these relationships areuncertain. Common triggers quoted are stress,hunger, and fatigue (these equally contribute totension headaches).
http://en.wikipedia.org/wiki/Tension_headacheshttp://en.wikipedia.org/wiki/Tension_headaches8/4/2019 Migraine and Anti Migraine Druigs
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Pathophysiology
Both vascular and neural influences causemigraines.
stress triggers changes in the brain
These changes cause serotonin and/orhistamine to be released
blood vessels constrict and dilate
chemicals including substance P irritatenerves and blood vessels causing neurogenicinflammation and pain.
http://en.wikipedia.org/wiki/Neurogenic_inflammationhttp://en.wikipedia.org/wiki/Neurogenic_inflammationhttp://en.wikipedia.org/wiki/Neurogenic_inflammationhttp://en.wikipedia.org/wiki/Neurogenic_inflammation8/4/2019 Migraine and Anti Migraine Druigs
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Cont..
The Vascular theory holds that initialvasoconstriction or shutting of blood throughcarotid arterio -venous anastomoses produces
cerebral ischaemia and starts the attack. The neurogenic theory considers it to be a
spreading depression of cortical electricalactivity followed by vascular phenomena.
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Postulated pathogenesis of migraine
Peripheral mechanisms
5-HT Dilatation of
receptor extracerebral vessels
5-HT Vascular NO 5-HT1D(-) sensory nerve
endothelium agonists discharge
sensitisation of
5-HT (-) sensory nerve
Antagonists 5-HT(-)
agonists
Release of mediators
(prostaglandins,kinins,etc) Neuropeptide release
(CGRP,SP)
NASIDS (-)
Neuroinflammation aura and pain
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Central mechanism
sensory nerve discharge
(-)5-HT1D agonist
central pain sensitisationUnknown factors aura & painspreading depression
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Antimagraine drugs
Mild: Simple analgesics (e.g.
aspirin,paracetamol,with or without
metoclopramide to hasten absorption )
NSAIDs or their combinations (+antiemetic)
Moderate:
NSAIDs combinations /ergot alkaloids /sumatriptan (+antiemetic)
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Severe
Ergot alkaloids/
Prophylaxis
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Tricyclic antidepressants (e.g.amitriptyline).
Clonidine, an alpha2-adrenoceptoragonist.
Calcium channel blockers :(e.g.Flunarizine, Dihydropyridines,verapamil)
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Reference
Goodman & Gilman's-manual ofpharmacology and therepuetics
Essentials of medical pharmacology-KD Tripathi.
www.wikipedia.com
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