Acute migraine treatments

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Acetaminophen and NSAIDS

  • First of treatment for mild migraines
  • Time to onset: 1-2 hours
  • Duration of effect: 2-3 hours, decreases with increasing frequency of use
  • Side effects: can lead to GI bleeding, liver and renal dysfunction.

Ergotamine Derivatives

  • Ergotamine are fungal derivatives that are potent vasoconstrictors.
  • Used for severe migraines.
  • Time to onset: 15 min to 2 hours depending on route.
  • Duration of effect: 2-4 hours.
  • Side effects: increased BP, MI, stroke.

Triptans

  • Triptans are 5HT1B, 5HT1D agonists.
  • Sumatriptan was the first to be introduced in 1991.
  • Sumatriptan is used for severe migraine with 10 min time to onset and 60-70% efficacy with a duration of 2 hours.
  • 2ndgeneration triptans have since been developed with increased efficacy and duration of action.
  • Side effects are referred to as triptan sensations and include tingling, numbing, anxiety, heaviness or tightness in the chest and throat, and sensations of warmth, burning, cold, or pressure.


Prophylaxis Treatment

  • Beta-blockers
  • Antidepressants
  • Calcium channel blockers
  • Anti-convulsants
  • Serotonin antagonists
  • Natural products
  • Newer treatments ( BOTOX)

Comments

Abigail said…
Acetaminophen and NSAIDs are NOT the first-line acute treatments recommended by Migraine experts. They canNOT abort the Migraine. The most recommended first-line treatments are the abortives, usually triptans.
July 5, 2008 at 8:15 PM
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