Antimigraine
Generic and Trade Names:
| Dihydroergotamine mesylate | D.H.E. 45 | ||
| Ergotamine/caffeine | Cafergot | ||
| Ergotamine | Ergostat | ||
| Isometheptene/Dichloralphen/APAP Midrin, Midchlor | |||
| Methysergide | Sansert | ||
| Naratriptan | Amerge | ||
| Rizatriptan | Maxalt | ||
| Sumatriptan | Imitrex | ||
| Zolmitriptan | Zomig |
Description:
These medications are used to treat migraine attacks once they occur. It is believed that a migraine attack is an interaction between the brain and the circulation the brain in people with unstable vascular and pain-control mechanisms. While peptides are undoubtedly involved in vasodilation, there is strong evidence that 5-HT plays an important part in the genesis of migraine. (Facts and Comparisons 1999)
It seems probable that the primary action of sumatriptan or ergotamine in terminating migraine headache is exerted on the cerebral and extracranial circulation whereas medications employed in prophylaxis may act centrally. (Lance 1992)
Migraine infrequently occurs more than two or three times a week for any period and usually responds to ergotamine, dihydroergotamine, sumatriptan, or a phenothiazine. Agents such as codeine or oxycodone for the occasional intractable attack may be used. When demands in a migraine patient for opioids in amounts greater than 10 to 15 tablets per month occur, there is obvious cause for concern. (Ziegler, 1997)
Nutritional Considerations:
Electrolytes should be maintained.
Avoid caffeine. (McKevoy 1998)
Limit smoking. (AMA, 1998)
There is a link with the non-selective, naturally occurring agonist, 5-HT (5-hydroxytryptamine) which is now available as a supplement ( 5-HTP ). (Cocks, 1993)
Limit alcohol use, which can aggravate drug side effects (Scott 1994).
Herbal Considerations:
Ergot alkaloids are derived from a plant disease, or fungus: Claviceps purpurea, or Secale cornutum (as in the German Commission E) which commonly affects rye grasses.
Avoid St. John's Wort (Pronsky 1999)
Black tea, cola nut, guarana, green tea, mate can all increase the GI absorption of ergotamine. (McKevoy 1998)
5-HTP can decrease the effects of methysergide. (Facts and Comparisons, 2000)
References
AMA. http://www.ama-assn.org/insight/spec_con/migraine/modmig.htm
Cocks TM: Comparison of contractile responses to 5-hydroxytryptamine and sumatriptan in human isolated coronary artery: synergy with the thromboxane A2-receptor agonist, U46619. Br J Pharmacol, 1993 Sep, 110:1, 360-8.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999, 2000.
Lance JW: The pathophysiology of migraine: a tentative synthesis. Pathol Biol (Paris), 1992 Apr, 40:4, 355-60.
McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
Pronsky, Z Food Medication Interactions, 11th edition 1999
Scott AK: Sumatriptan clinical pharmacokinetics. Clin Pharmacokinet, 1994 Nov, 27:5, 337-44.
Stricker BH et al., [Registration of suspected adverse effects by the Bureau Adverse Effects Drugs; research activities in 1993 (published errata appear in Ned Tijdschr Geneeskd 1994 Nov 12;138(46):2328 and 1994 Dec 31;138(53):2688)] Ned Tijdschr Geneeskd, 1994 Oct, 138:42, 2110-3.
Ziegler DK: Opioids in headache treatment. Is there a role? Neurol Clin, 1997 Feb, 15:1, 199-207.
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