Headache Drugs

Question 1

Describe the headache classifications

Answer 1

Primary headaches

Tension Headaches:

• Mild-moderate; Bilateral, Nonpulsatile; Band-like pressure
• Prevention: Amitriptyline
• Treatment: Muscle Relaxants & NSAIDs

Migraine Headaches:

• Moderate-Severe; Often unilateral, Usually pulsatiles; w/ or w/o aura
• Prevention: B-antagonists, Antidepressants, CCB’s, NSAID, 5HT inhibitors
• Treatment: DHE, Ergotamine, NSAID, Triptans

Cluster Headaches:

• Severe; Unilateral, Retro-orbital; Clustered over time
• Prevention: Lithium, Verapamil
• Treatment: DHE, Ergotamine, Glucocorticoids, Lidocaine, Oxygen, & Sumatriptan

Question 2

Describe the MoA of Migraines.

How do Ergot Alkaloids & Triptan drugs act to prevent these?

Answer 2

Migraine, the most common headache disorder, is believed to result from neurovascular dysfunction at several levels in the CNS.

Cerebral vasoconstriction and ischemia are followed by vasodilation, inflammation, and a unilateral, pulsatile headache.

Ergot Alkaloids & Triptan drugs:

1. Vasoconstriction
2. inhibition of Peptide release
3. inhibition of Trigeminal neuron activation

Question 3

A 26-year-old woman who has frequent migraine headaches reports to her physician that the drug she has been taking to stop her migraine attacks is not working anymore.

The physician looks in her medical record and tells her that he prescribed sumatriptan on her last visit a month ago, and that she may be tolerant to its effects.

The physician talks to her about trying a drug to prevent migraine attacks as well as a new drug to abort migraines.

She agrees to this new strategy and is prescribed valproate for migraine prevention and a new intranasal formulation of dihydroergotamine for aborting a migraine attack.

Answer 3

Migraine is an extremely common condition that will affect 12% to 28% of people at some point.

• It is more common in women than in men, with about 25% of adult women experiencing a migraine headache at least once a year, compared with less than 10% of men.

Too-frequent use of an abortive agent for migraine headaches, such as sumatriptan, can lead to loss of effectiveness; another antimigraine agent can be administered and might be effective.

In the case presented, an ergot alkaloid, dihydroergotamine (DHE), which is now available in a convenient and rapid-acting nasal inhalation formulation, was prescribed.

• This class of drugs, however, carries potential risks for serious adverse effects, including ischemic conditions, and frequency of their use should be limited.

Valproate is an antiseizure drug that is commonly used for migraine prophylaxis.

• It has an onset of action of a couple of weeks, which may be shorter than other agents used to prevent migraine attacks.

Propranolol, a β-blocker, is also used to prevent the occurrence of migraine headaches, and its use in controlled clinical studies did not show tolerance in migraine sufferers who used it for at least 6 months.