Migraine

Due to the difficulties in diagnosing this unit, patients often have to undergo many consultations with a doctor for thorough diagnosis.

Migraine is defined as a chronic and recurrent disease with paroxysmal, most often unilateral, headaches. Patients describe pain as severe, throbbing on one side, accompanied by nausea, vomiting, photophobia, and hypersensitivity to sounds. This pain may increase with physical activity, hunger and stress. The causes are vasomotor disorders. During the heraldry period (aura), vasospasm occurs, followed by vasodilation, especially of the extracerebral vessels, and severe pulsating pain.

There are two clinical forms of migraine: with or without aura.

Migraine without aura is much more common and is characterized by a slowly increasing headache lasting from 18 to 72 hours, accompanied by nausea, vomiting. Carrying out daily duties brings severe pain.

A less common subtype of pain is migraine with aura. It is distinguished by the fact that before the onset of headaches, there are temporary, usually 5-20 minutes unusual symptoms such as: visual disturbances – light phenomena in the form of flickering and flashes – visual acuity disturbance, impaired sensation. There are also problems with speech.

Factors that trigger migraine headache include mental stress, alcohol, foods containing tyramine (chocolate), hormonal changes in women during the menstrual cycle, certain oral contraceptives, pregnancy and menopause, changes in weather, sleep disturbances, hunger or skipping a meal. The following factors may also be responsible for the occurrence of an attack: neck pain, bright light, alcohol, smoke, overexertion.

Farmakoterapia migreny

The goal of drug therapy is to control nausea and vomiting, as well as pain and inflammation. An ideal remedy should also affect vascular disorders.

Different groups of drugs are used to treat migraine attacks:

• According to the current recommendations, mild or moderate migraine headaches are fought with non-steroidal anti-inflammatory drugs: acetylsalicylic acid, ibuprofen, diclofenac, naproxen, tolfenamic acid. In case of nausea, antiemetics should be administered: metoclopramide, domperidone or prochlorperazine in combination with NSAIDs. NSAIDs should be administered as soon as possible and in the maximum single dose. It is worth emphasizing that a patient who is struggling with this disease should not use painkillers in excessive amounts, as this may lead to an increase in the frequency of headaches.

• TRIPTANY is used in the pharmacotherapy of moderately severe, severe and long-lasting migraine attacks. They are agonists of serotonin (5-HT) receptors and thus cause contraction of the blood vessels dilated as a result of a migraine attack and inhibit the release of neuropeptides from activated trigeminal nerve endings and block pain transmission. In Poland, the following preparations are available for the acute treatment of migraines: SUMATRYPTAN, RYZATRYPTAN, ZOLMITRYPTAN, ELETRYPTAN. ELETRYPTAN shows the greatest effectiveness in many studies. The greatest pharmacological effect of triptans is when we give them earlier, when the pain is still mild. Common side effects include: hot flushes, a feeling of heaviness and pressure in various parts of the body (especially in the chest and neck).

• Ergot alkaloids – ERGOTAMINE are an alternative to triptans used in the case of severe migraine attacks. They belong to the non-selective serotonin receptor agonists, showing a very strong anti-migraine effect by constricting intracranial vessels. Medicines from this group have already lost their importance due to the occurrence of dangerous side effects after their use. Prolonged and excessive use of ergotamine may cause peripheral limb ischemia, coronary artery stenosis, myocardial infarction, and cerebral ischemia. The abuse of ergot derivatives can lead to chronic headaches and withdrawal symptoms when they are stopped. It should be emphasized that the dose of ergotamine should be taken as soon as possible at the first sign of an attack. The following preparations are available in Polish pharmacies: Bellergo, Ergotaminum Filofarm.

Migraine prophylaxis

The fundamental goal of prophylaxis is to reduce the frequency and severity of migraine attacks, which will reduce the habitual use of painkillers. Preventive treatment should be initiated if the patient has two to three seizures a month or these incidents cause great discomfort in everyday life.

The drugs recommended in the prevention of migraine include:

• β-blockers: propranolol, metoprolol, atenolol,
• calcium antagonists – flunarizine,
• tricyclic antidepressants – amitriptyline, for migraine with tension headaches or in patients with depression
• antiepileptic drugs – valproic acid, topiramate,
• sartans- candesartan.

Other preventive methods include the use of:

• magnesium in the form of citrate,
• riboflavin,
• leaf and herb chrysanthemum,
• acupuncture.

and avoiding excessive consumption of food and fluids in the evening, adequate sleep time, and limiting alcohol consumption.

Such a common disease as migraine is a big problem for doctors and patients themselves. Pharmacotherapy is quite complicated because it is characterized by high inter-individual variability and often does not bring the desired results. Patients often abuse painkillers for many years, which only worsens their condition. That is why it is extremely important to consult a specialist who will thoroughly and individually analyze a given case and implement appropriate pharmacotherapy.

Literature:

1. E. Mutschler, G. Geisslinger, H. K. Kroemer, P. Ruth, Mutschler Farmakologia i toksykologia.
2. A. Szczeklik, P. Gajewsk, Interna Szczeklika .
3. Farmakodynamika,  podręcznik dla Studentów Farmacji
4. P.K. Tuszyński, Ból z perspektywy farmaceuty
5. Mattias Linde ,Migrena: współczesne kierunki leczenia