migraine

Prepard by : may saadSona daraghmah To dr : ola ayesh

Migraine

is a debilitating condition characterized by moderate to severe headaches, and nausea. It is about three times more common in women than in menThe typical migraine headache is unilateral pain and pulsating in nature and lasting from 4 to 72 hours

• symptoms• Nausea• Vomiting• photophobia • phonophobia (increased sensitivity to sound)• the symptoms are generally aggravated by routine

activity Approximately one-third of people who suffer from migraine headaches perceive an aura unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur

Phases of migraine attack

• The prodrome, which occurs hours or days before the headache.

• The aura, which immediately precedes the headache.

• The pain phase, also known as headache phase.

• The postdrome.

Prodrome

• Prodromal symptoms occur in 40–60% of those with migraines. This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles

Aura

• For the 20–30%of migraine sufferers who experience migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes

Pain

• he typical migraine headache is unilateral, throbbing, and moderate to severe and can be aggravated by physical activity Not all these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, and may occur primarily on one side or alternate sides from one attack to the next. The onset is usually gradual

Postdrome

• The effects of migraine may persist for some days after the main headache has ended. Many sufferers report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The patient may feel tired or "hungover" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness.

Cause

• The cause of migraines is unknown

Triggers

• The most common triggers quoted are stress, hunger, and fatigue; however, these equally contribute to tension headaches

• A 2003 review concluded that there was no scientific evidence for an effect of tyramine on migraine

• A 2009 review found little evidence to corroborate the environmental triggers reported While monosodium glutamate is frequently reported as a dietary trigger evidence does not consistently support this

Pathophysiology

• Migraine is a neurovascular disorder• Although migraine is thought by some to be a

neurological disease, in the absence of scientific evidence, this remains a hypothesis.

Prevention

• Preventive (also called prophylactic) treatment of migraines can be an important component of migraine management. Such treatments can take many forms, including

• taking preventative drugs,• migraine surgery,• taking nutritional supplements, • lifestyle alterations such as increased exercise• avoidance of migraine triggers, .

Management

• There are three main aspects of treatment: trigger avoidance, acute symptomatic control, and pharmacological prevention Medications are more effective if used earlier in an attack.

Analgesics

• A number of analgesics are effective for treating migraines including:

• Non-steroidal anti-inflammatory drugs (NSAIDs

• Paracetamol/acetaminophen either alone or in combination with metaclopramide is effective for migraines

• Simple analgesics combined with caffeine may help caffeine can be useful during an attack despite the fact that in general migraine-sufferers are advised to limit their caffeine intake

Triptans

• Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of people They come in a number of different forms including oral, injection, nasal spray, and oral dissolving tablets] Most side effects are mild such as flushing however rare cases of myocardial ischemia have occurred They are non addictive, but may cause medication overuse headaches if used more than 10 days per month.

Ergotamines

• Dihydroergotamine is an older medication that some find useful They were the primary oral drugs available to abort a migraine prior to the triptans. They are much less expensive than triptans and continues to be prescribed for migraines.

Corticosteroids

• single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours.

GENERIC NAME: sumatriptan BRAND NAME: Imitrex, Alsuma

Sumatriptan

• Sumatriptan is a triptan sulfa drug containing a sulfonamide group for the treatment of migraine headaches. Imitrex is marketed and manufactured by GlaxoSmithKline as well as various generic drug manufacturers.

• Systematic (IUPAC) name1-[3-(2-dimethylaminoethyl)-1H-indol-5-yl]- N-methyl-methanesulfonamide

• PREPARATIONS: Tablets: 25, 50, 100 mg. Intranasal Solution: 5, 20 mg. Injection Solution: 4 and 6 mg/0.5 ml

• STORAGE: Sumatriptan should be stored between 2-30 C (36-86 F).

• PRESCRIBED FOR: All formulations of sumatriptan are used for acute treatment of migraine headaches with or without an aura in adults. The injectable formulation also is used for treating cluster headaches.

Half life 1.5_2.6 hours

Approval and availability

• Sumatriptan was the first triptan available (in 1991), and, in the United States and most developed countries, is available only by medical prescription. Several dosage forms for sumatriptan have been approved, including tablets, solution for injection, and nasal inhalers.

• In the United Kingdom, sumatriptan is available over the counter, under the names Imigran Recovery and Migraleve Ultra. It is sold in packs of two 50 mg tablets for approximately £7.99 (equivalent to about $12

• On April 15, 2008, the US FDA approved a combination of sumatriptan and naproxen, an NSAID, which is marketed in the USA under the trade name Treximet This combination has shown a benefit over either medicine used separately.

• In July 2009, the US FDA approved a single-use jet injector formulation of sumatriptan. The device delivers a subcutaneous injection of 6 mg sumatriptan.

Mode of action

• Sumatriptan is structurally similar to serotonin (5HT), and is a 5-HT agonist. The specific receptor subtypes it activates are present on the cranial arteries and veins. Acting as an agonist at these receptors, Sumatriptan reduces the vascular inflammation associated with migraine

Why is this medication prescribed?

• Sumatriptan is an antimigraine medicine. Migraine headaches are believed to result from dilatation of the blood vessels in the head.

• This medicine is usually used for people whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

Despite that sumatriptan is highly effective in relieving migraines, it unfortunately does not prevent or reduce the number of attacks.

Side effects

• Large doses of sumatriptan (200 mg/day) can cause sulfhemoglobinemia, a rare condition in which the blood changes from red to greenish-black, due to the integration of sulfur into the hemoglobin molecule If sumatriptan is discontinued, the condition reverses within a few weeks.

• Serious cardiac events, including some that have been fatal, have occurred following the use of Imitrex Injection or Tablets. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia,

• The most common side-effects reported for migraine are atypical sensations (paresthesias and warm/cold sensations)

• neurological events (vertigo) • Malaise/fatigue occurred in less than 1%

Pharmacokinetics

• Sumatriptan is administered in several forms; tablets, subcutaneous injection, and nasal spray. Oral administration (as succinate) suffers from poor bioavailability, partly due to presystemic metabolism—some of it gets broken down in the stomach and bloodstream before it reaches the target arteries. A new rapid-release tablet formulation has the same bioavailability, but the maximum concentration is achieved on average 10–15 minutes earlier.

• When injected, sumatriptan is faster acting (usually within 10 minutes), but the effect lasts for a shorter time. Sumatriptan is metabolised primarily by monoamine oxidase A into an indole acetic acid analogue, part of which is further conjugated with glucuronic acid. These metabolites are excreted in the urine and bile. Only about 3% of the active drug may be recovered unchanged

DRUG INTERACTIONS

• Monoamine oxidase inhibitors, for example, isocarboxazid and procarbazine may reduce the breakdown of sumatriptan in the liver, leading to increased blood levels and side effects of sumatriptan.

• Combining sumatriptan with sibutramine selective serotonin reuptake inhibitors SSRIs, including fluoxetine (Prozac), citalopram

• or serotonin and norepinephrine reuptake inhibitors, including venlafaxine and desvenlafaxine may increase the concentration of serotonin in the brain, causing increased serotonin-related side effects.

Specific population

• PREGNANCY: Safe use in pregnancy has not been established.

• NURSING MOTHERS: Sumatriptan is excreted in breast milk. Infant exposure may be reduced by avoiding breast feeding for 12 hours after administration of sumatriptan.

Contraindications

• Adminesreing sumatriptan within 24 hours of treatment with an argot containing medication (dihydroergotamine,ergotamine)is CI because such combinatuion increase the likelihood of vasospasm

SUMATRIPTAN WARNING Sumatriptan should not be given to those with high blood pressure or who have or are at risk

of heart disease or condition.

It should not be used if you have liver or kidney disease.

Sumatriptan must not be given for 2 weeks after taking an MAO inhibitor drug

If you develop severe chest pain after taking Sumatriptan, seek medical help right away.

Sumatriptan injections should not be injected into a vein. This could result in a serious heart irregularity

Though rarely, severe and fatal allergic reactions have occurred in people taking Sumatriptan. In rare cases, people taking Sumatriptan have suffered seizures.

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Thank you for attention