MIGRAINE

Puja Adhikari
B . Pharm . Second Semester
School of Health And Allied Science
Pokhara University

Date =2081-01-21 1
 CONTENTS
• Introduction
• Definition
• Migraine triggers
• Phases
• Classifications
• Diagnosis and medication options
• Goals for treatment
• Management
• Guidelines
• Summary of prevention
• Conclusion
• References
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Introduction And Definition
• Migraine is one of the common causes of recurrent headaches.
• Migraine is under diagnosed and undertreated.
• Migraine is derived from the Greek word meaning 'pain involving half
the head’.
• It is more common in females (18% of women, 6% men).
• It’s peaks between 20 and 50 years.
• The frequency of headaches reduces after the age of 50.
• Migraine is a primary headache disorder characterized by a recurrent
headache that is moderate to severe felt as a throbbing pain on one
side of the head.

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 Migraine triggers
• Disturbed sleep pattern
• Hormonal changes
• Drugs
• Physical exertion
• Visual stimuli(bright lights )
• Auditory stimuli (loud sounds )
• Olfactory stimuli
• Weather changes
• Hunger(fasting , skip meals )
• Psychological factors

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 PHASES
• Prodrome
• Aura
• Headache
• Postdrome

PRODROME
Vague premonitory symptoms that begin from 12 to 36 hours before the aura and headache.
Symptoms:
• Yawning
• Excitation
• Depression
• Lethargy
• Craving or distaste for various foods
Duration: 15 to 20 min.

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 AURA
Aura is a warning or signal before onset of headache.
Symptoms:
• Flashing of lights
• Zig-zag lines
• Difficulty in focusing
Duration : 15-30 min
HEADACHE
Headache is generally unilateral and is associated with SYMPTOMS like:
1. Anorexia
2. Nausea
3. Vomiting
4. Photophobia
5. Phonophobia
6. Tinnitus
Duration: 4-72 hrs.

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 POSTDROME

Following headache, patient complains of -

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 DIAGNOSIS
• Medical History
• Headache diary
• Migraine triggers
• Investigations
✓EEG
✓CT scan
✓MRI
MEDICATION OPTIONS
► Aspirin or paracetamol.
► Paracetamol or ibuprofen (for children).
► Consider NSAIDs (e.g. ibuprofen, naproxen, diclofenac rapid).
► Triptan preparation: tablet, nasal spray or SC injection used in moderate to severe
attacks.
► Ergotamine in case of severe attacks.
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 GOALS OF TREATMENT
• Establish diagnosis.
• Educate patient.
• Discuss findings.
• Establish reasonable expectations.
• Involve patient in decision.
• Encourage patient to avoid triggers.
• Choose the best treatment.
• Create treatment plan.

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 MANAGEMENT

1. Non-pharmacological treatment:-
• Identification of triggers
• Meditation
• Relaxation training
• Psychotherapy
2. Pharmacotherapy:-
• Abortive therapy
• Preventive therapy
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 Medications
Aborative Medications
• Analgesics with caffeine (PCM , acetaminophen, aspirin and caffeine).
• Analgesics with caffeine and barbiturates .
• Non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen ,
naproxen sodium .
• Triptans (Suma , riza, Nara , algo, zolmi -5HT 1B/1D agonist )
• Antiemetics (domperidone )
Preventive Medications
• Beta blockers (propranolol , metoprolol )
• Calcium –channel blockers
• Antidepressants
• Anticonvulsants
• NSAIDs 11
 GUIDELINES
• Migraine significantly interferes with patient's daily routine, despite
acute treatment.
• Acute medications ineffective, intolerable, overused.
• Frequent headache.
• Uncommon migraine conditions.
• Cost considerations.
• Patient preference.
SUMMARY OF PREVENTION
• Use preventive medications when needed.
• Treat long enough.
• Avoid acute medications overuse.
• Take coexisting conditions into account. 12
 CONCLUSION
• It is more common in adults than children and in women than men.
While researchers have some idea of what happens within the brain
during migraine attacks, much remains to be discovered about its
underlying causes and mechanisms.
• In addition, treatment focuses on avoiding those things that seem to
trigger attacks, identifying drugs that prevent or reduce the severity of
attacks and drugs that reduce the intense pain of a severe attack.
• The good news is that several classes of drugs are effective for
different kinds of migraine and most migraine sufferers can work with
their doctor to minimize migraine's effects.

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Fig :migraine medication
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 REFERENCES
• Headache Classification Committee The International Classification of
Headache Disorders. 2nd edition. Cephalalgia. 2004;24:1-160.[saga
journals ]
• Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF.
Migraine prevalence, disease burden, and the need for preventive
therapy. Neurology. 2007;68:343-9.[ResearchGate / neurology
journals ]
• Radat F, Swendsen J. Psychiatric comorbidity in migraine: A review.
Cephalalgia. 2004;25:165-178
• https://www.slideshare.net/sarangidipu/migrane-ppt

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THANK YOU !!!

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