Research Paper: Migraine Pt Migraine Headaches Typically

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[. . .] These medications aim to stop the progression of the headache that has already begun as opposed to identifying triggers or using medications to prevent the onset of headaches (Sheikh & Matthew, 2012). Abortive medications include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin receptor (5-HT1) agonists (triptans), ergot alkaloids, and antiemetics.

Triptans are believed to work via vasoconstriction of the cerebral blood vessels which results in a decrease in neuropeptide release and the neurons in the trigeminal complex. The most widely studied triptan is sumatriptan (Imitrex; Sheikh & Matthew, 2012). Sumatriptan relieves migraines via enhancing the action of serotonin receptors in the brain leading to vasoconstriction. It is also believed to reduce pain signal transmission in the brain. Sumatriptan comes as a tablet, nasal spray, or as an injectable. Typically there are few side effects, but these can include dizziness, flushing, pain or tightness in the chest or throat, abdominal discomfort, sweating, and in rare cases elevated blood pressure. Combining it with selective serotonin reuptake inhibitors (SSRI's) will increase serotonin levels and other medications should be monitored (Sheikh & Matthew, 2012). There are other triptans available that vary in their chemical composition, time of onset, and tolerability.

There are also some agents that are prophylactic in nature and these include the following: antiepileptic drugs, beta blockers, tricyclic antidepressants, calcium channel blockers, SSRIs, NSAIDs, other serotonin antagonists, and botulinum toxin (Sheikh & Matthew, 2012). Preventive medications for migraine appeared to be under used and that about one third of people who suffer from migraine headache could benefit from the use of prophylactic medications (Sheikh & Matthew, 2012). These medications can help to decrease the intensity and the frequency of a person's migraine headaches. People who have migraine headache frequency greater than 15 days a month (chronic migraine headache; Olesen, J., Bousser, M.G., Diener, H.C., Dodick, D., First, M, et al., 2006) typically do get started on some form of preventive/prophylactic medication.

There some basic guidelines that involve selecting a prophylactic medication use for patient with migraine headache (Sheikh & Matthew, 2012). The first one is to be fully informed of the patient's comorbid medical conditions. The reason for this is medications are often used to treat more than one condition and the person may already be on a medication that is considered a prophylactic treatment for migraine. In addition, understanding a person's comorbid conditions and current medication regime also helps to determine whether a specific prophylactic medication is not indicated for the patient.

The beta blocker propranolol (Inderal) has received good empirical support as a potential prophylactic medication for migraine headache (Sheikh & Matthew, 2012). Propranolol is a non-selective beta blocker. It acts by inhibiting the action of epinephrine and norepinephrine on both ?1- and ?2-adrenergic receptors; however, its exact mechanism in the prevention of migraine headache is unclear at this time.

Propranolol should not be taken by people who have asthma or insulin-dependent diabetes and used sparingly in people with a history of risk factors for depression or heart failure. Side effects of propranolol include cardiac arrhythmia, depression, insomnia, dizziness, fainting, nausea, jaundice, shortness of breath, itching, edema, dark urine, and other gastrointestinal issues.

There are numerous options for both abortive and prophylactic treatment of migraine headache which can be determined based on the patient's medical history, pattern of headaches, preferences of the patient, and consideration of the potential maximum benefits and minimum detriments. The current patient should be started on an abortive medication and then this medication can be supported by any number of appropriate prophylactic treatments including medications and behavioral strategies. The behavioral strategies can be determined by carefully studying the patient's daily headache log and determining the triggers of the patient's migraines, the effectiveness of current treatment, and the effect of the patient's migraines on her current lifestyle.

References

Bigal, M.E., & Lipton, R.B. (2009). The epidemiology, burden, and comorbidities of migraine.

Neurologic Clinics, 27(2), 321-334.

Burton, W.N., Landy, S.H., Downs, K.E., & Runken, M.C. (2009). The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clinic Proceedings, 84(5), 436-445.

Martin, P.R. (2010). Behavioral management of migraine headache triggers: learning to cope with triggers. Current Pain and Headache Reports, 14(3), 221-227.

Sheikh, H.U., & Matthew, P.G. (2012). Acute and preventive treatment of migraine headache.

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