偏头痛地中海ications

Migraineis a serious, potentially life-threateningneurologicaldiseasethat affects nearly 36 million Americans, the majority of whom are women. The American Migraine Foundation estimates that oneinevery four American households has at least one member with migraine. The hallmarksymptomof migraine is an escalating, often unbearable, debilitatingheadachethat is commonly described as intense throbbing or pulsatingpainin one area of the head. The pain may be accompanied by extremesensitivityto light and sound,nausea, and vomiting. In some people, migraines are preceded by visual disturbances known as auras that may includeflashinglights, zigzag lines, or temporaryblindness.

Migraine medicationsdo notcuremigraines. Instead, migraine drugs treat the symptoms using one of two approaches.

• Some migraine drugs relieve symptoms.
• Other migraine drugs are used to prevent a migraine attack.

Many migraine sufferers rely on simple pain relievers to get through an attack. Theserangefromover-the-counteranalgesics likeacetaminophentoanti-inflammatories likenaproxenoribuprofen(Motrin) toprescriptionbarbiturate combinations and narcotics. While this type of treatment provides relief, it doesn't target the physiological processes that underlie a migraine attack.

Migraine symptoms occur, in part, because of thedilationofbloodvessels in thebrain. Until recently, migraine sufferers had few choices when it came to drugs to counteract this effect. But newer migraine drugs known as triptans cause constriction of blood vessels and also bring about a general interruption in the chain of chemical events that leads to a migraine.

At some point, a migraine sufferer may need to move on to preventativetherapy. This usually becomes necessary when migraine attacks happen more than once a week and/orabortivemedications fail to work more than half the time.

No migraine drugs specifically prevent migraines. But many drugs used for other conditions can help keep migraines at bay. These include certain血压medications as well as someantidepressants, anti-seizuredrugs, and herbals.

Some of the migraine medications used to treat or prevent migraine headaches are also used for other conditions. Here are the pain reliever medications for migraine therapy.

• Antidepressants,
• anticonvulsants,
• antihistamines, and
• narcotics

There are some migraines drugs, though, that are used because they directly target the pain pathways associated with migraine headaches rather than pain pathways in general.

Migraine medications fall into twomajorcategories.

• The first contains drugs that abort or stop migraines from progressing once they begin. The earlier these drugs are used in a migraine attack, the better they work.
• The second category contains drugs that prevent migraines from happening.

Over-the-counter migraine medications used to address pain include analgesics,NSAIDS, andcaffeine, including:

• Aspirin
• Naproxen (Aleve,Naprosyn, Anaprox, Anaprox DS)
• Ibuprofen (Advil, Motrin)
• Acetaminophen (Tylenol)
• Or combinations of these

One drawback to using analgesics and NSAIDs is that taking them daily can make headaches worse due tomedicationoveruse.

Prescription drugs used to provide relief from pain include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) and
• Narcotics

Like over-the-counter medications, prescription drugs often come in combinations:

• A barbiturate calledbutalbitalis often used in combination with acetaminophen, and
• Caffeine with or withoutcodeine(anarcotic)

Barbituratesare asedativeand may be useful to help peoplesleepoff the pain.

While analgesics, NSAIDs, and narcotics relieve pain, they don't address the underlyingphysiology-- primarily the dilation of blood vessels in the brain. Two classes of migraine drugs are:

• Ergotamines and
• Triptans

Ergotalkaloids -- such as ergotamine tartrate (Cafergot) and dihydroergotamine mesylate (D.H.E. 45 Injection,MigranalNasalSpray) -- are potent drugs that constrict blood vessels. Because nausea is a possible side effect of these migraine drugs, some people take ergotamines in combination with other drugs to prevent nausea.

Triptans targetserotoninreceptors. These drugs cause constriction of blood vessels and bring about a general interruption in the chain of chemical events that lead to a migraine. Triptans include:

• Almotriptan (Axert)
• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan(Amerge)
• Rizatriptan (Maxalt, Maxalt-MLT)
• Sumatriptan(Imitrex,Zecuity)
• Zolmitriptan(ZomigZomig-ZMT)

While specific triptans differ in their ability to prevent arecurrenceof migraine headaches, they are generally equally effective in their ability to provide relief. Triptans are more migraine-specific than the earlier ergotamines.

另一个偏头痛药物流产的痛苦migraine is a combination product containing the vasoconstrictor isometheptene mucate, the sedative dichloralphenazone, and theanalgesicacetaminophen (Midrin). TheFDAhas classified isometheptene mucate as "possibly" effective for migraines, pending further review.

Antihistamines are also used to ease migraine symptoms. These drugs counteract the effect ofhistamine, asubstancethat dilates blood vessels and causes aninflammatory responsein the body -- the same kinds of response seen during a migraine attack. Antihistamines are broadly grouped into sedating and non-sedating types. An example of a sedating type isdiphenhydramine; an example of the non-sedating type is loratadine (他定).

Calcitonin-generelatedpeptide(CGRP) antagonists are a newer type of migraine medication. CGRP is a neuropeptide, which neurons use to communicate. It was discovered in the 1980s and it seems to play a key role in migraine. It is not entirely understood how CGRP causes the pain of migraines. One theory is that CGRP sensitizesperipheralnerves, which in turn send signals to thecentral nervous system(CNS) thattriggerthe pain and sensitivity tosensorystimuli associated with migraine. This may occur because when CGRP binds to itsreceptor, it sensitizes the nerves by increasing their rate of firing. CGRP might also activate pain receptors bydilatingblood vessels, which could push on pain receptors onadjacentnerves.

There are two kinds of CGRP antagonists:

• Monoclonalantibodies
  • Eptinezumab (Vyepti)
  • Erenumab (Aimovig)
  • Fremanezumab (Ajovy)
  • Galcanezumab (Emgality)
• Oralgepants (an older class of CGRPantagonist)
  • Rimegepant (Nurtec)
  • Ubrogepant (Ubrelvy)

CGRP antagonists have fewer side effects than many other migraine medications, and often work where others have failed.

Preventative therapy should be considered for patients who suffer fromrecurrentmigraines that cause significant disability, frequent migraines that require treatment more than twice a week, or migraines that do not respond or respond poorly tosymptomatictreatments. Currently there are no drugs that specifically target and prevent migraines. Certain blood pressure medications as well as some antidepressants, anti-seizure drugs, and herbals have been shown to have beneficial effects in preventing migraine headaches. It's important to understand that道具hylacticmedicines may not produce any significant benefits right away and maximal effects may not be seen for weeks to up to 6 months.

Although a number of medications have been used for the prevention of migraines, the medications that have been shown to be effective in controlledclinical trials, and are therefore recommended by the American Headache Society and the American Academy ofNeurology(AAN) migraine prevention guidelines include:

• Divalproex sodium/sodiumvalproate
• Topiramate (Topamax)
• Metoprolol (Lopressor,Toprol XL)
• Propranolol(Inderal)
• Timolol(Blocadren,Betimol)

Other medications that are used to prevent migraine headaches include:

ACE Inhibitors

• Lisinopril(Prinivil/Zestril)

Angiotensin II Receptor Antagonists (ARBS)

• Candesartan (Atacand)

Beta-blockers

• Atenolol(Tenormin)
• Nadolol

Calcium Channel Blockers

• Diltiazem(Cardizem LA)
• Nimodipine (Nimotop)
• Verapamil(Isoptin,Calan)

Tricyclic Antidepressants

• Amitriptyline(Elavil)
• Nortriptyline(Nortriptyline Hydrochloride,Nortriptyline Hydrochloride Oral Solution,Pamelor)
• Imipramine
• Doxepin(Silenor)
• Protriptyline (Vivactil)

Other Antidepressants

• Paroxetine(帕罗西汀)
• Fluoxetine(Prozac)
• Sertraline(Zoloft)

Antiseizure Medications

• Topiramate (Topamax)
• Gabapentin(Neurontin)
• Divalproex sodium (Depakote)

Herbals

• Feverfew
• Butterbur
• Coenzyme Q10(CoQ10)
• Magnesiumsupplements

CGRP Antagonists

• Monoclonal antibodies
  • Eptinezumab (Vyepti)
  • Erenumab (Aimovig)
  • Fremanezumab (Ajovy)
  • Galcanezumab (Emgality)
• Oral gepants (an older class of CGRP antagonist)
  • Rimegepant (Nurtec)
  • Ubrogepant (Ubrelvy)

Triptans can cause:

• Tingling
• Sleepiness
• Flushing
• Throatandchesttightness

The most common side effect of ergotamines is nausea.

Side effects of beta-blockers include:

• Fatigue
• Depression
• Nausea
• Insomnia
• Dizziness
• Lowered blood pressure

Calcium channel blockerscan cause:

• Weight gain
• Constipation
• Dizziness
• Low blood pressure

Tricyclic antidepressantsare associated with:

• Weight gain
• Dry mouth
• Sedation
• Decreasedlibido

Other antidepressants may cause weight change and decreased libido.

The side effects of anti-seizure medicationsdepend on the specific drug.

Divalproex sodium can cause:

• Diarrhea
• Dizziness
• Drowsiness
• Hair loss
• Ringing in the ears
• Visual changes
• Shakiness
• Unsteadiness
• Weight changes

Gabapentin may cause:

• Drowsiness
• Dizziness
• Unsteadiness
• Fatigue
• Visual changes
• Drymouth
• Weight gain
• Nausea
• Constipation

Side effects of topiramate include:

• Weakness
• Fatigue
• Drowsiness
• Dizziness
• Confusion
• Difficulty concentrating
• Tingling of hands andfeet
• Loss of appetite
• Diarrhea
• Impotence
• Weight loss

The side effects associated with the herbals used for migraines include burping andgastrointestinalissues.

CGRP antagonists have fewer side effects than many other migraine medications and may include:

• Pain at the injection site
• Constipation

In 2006, the FDA warned about combiningtriptandrugs with selective serotoninreuptakeinhibitors (SSRIs) and selectivenorepinephrinereuptake inhibitors (SNRIs). Taking the drugs together could cause an overload of serotonin in the body, causing what is known as the "serotoninsyndrome.” Symptoms of this life-threateningconditioninclude a rapid increase in blood pressure, fastheart rate, and increased bodytemperature.

SSRIs include:

• Citalopram(Celexa)
• Escitalopram(Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• 奥氮平/fluoxetine (Symbyax)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

SNRIs include:

• Duloxetine(Cymbalta)
• Sibutramine (Meridia)
• Venlafaxine(Effexor)

Ergot alkaloids should not be used concurrently with drugs that inhibit a certainliverenzyme. Doing so could result in a life-threatening decrease in blood flow to the extremities and/or brain. These drugs include:

• Macrolideantibiotics such aserythromycin(Benzamycin, Engel,Ilotycin)，clarithromycin(Biaxin, Biaxin XL), and troleandomycin (Tao)
• HIVproteaseinhibitors such as ritonavir (Norvir) or indinavir (Crixivan)
• Azole antifungals such asketoconazole,fluconazole(Diflucan)，itraconazole (Sporanox)

The use of topiramate (Topamax) can result in decreasedsweatingand increased body temperature. This may be especially concerning during hot weather. Wearing light clothes and drinking plenty of fluids while using topiramate during warmer months is very important. Aphysicianshould be consulted if body temperature rises.

Serious complications of constipation and new-onsetor worsening of pre-existinghigh blood pressure(hypertension) may occur with the calcitonin-gene related peptide (CGRP) antagonist erenumab (Aimovig).

Migraine headaches may become less frequent during pregnancy. However, in rare cases, migraines may appear for the first time during pregnancy or become worse. Non-drug therapies are considered to be safer during pregnancy, they should be tried first. Non-drug therapies such as relaxation, sleep,massage, ice packs, and lifestyle changes are considered first-line options during pregnancy.

If drug treatment is required, acetaminophen (Tylenol) is usually the treatment of choice. When used appropriately, acetaminophen treatment does notaffectthe pregnancy or the unborn baby.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered second-line options and thought to be safest in the secondtrimester. They should not be used near the time of birth. Opioids are third-line options. Prolonged use of opioids may causeaddictionand dependence in mothers and children.

Triptans are reserved for moderate-to-severe symptoms in women who have failed to adequately respond to other treatments. Sumatriptan is the oldest and most studied triptan in pregnancy. A pregnancyregistryfor sumatriptan did not find an increased risk of birth defects ormiscarriagein 600 patients who were treated with sumatriptan during pregnancy.

Ergotamines should not be used during pregnancy as they may potentially induce hypertonic uterine contractions and vasospasms/vasoconstrictions which can cause harm to the unborn baby.

Pregnantwomen who suffer from frequent migraine headaches may benefit from preventative therapy. Beta-blockers such as propranolol, metoprolol, and atenolol are generally considered to be safe options. Verapamil is the preferredcalcium channel blockerbecause it is relatively safe and has good tolerability. Low-dose antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) may also be considered in some patients, especially those who have underlying depression.

Although it is safest to avoid all medications if breastfeeding, this is not always feasible. Therefore, to avoid unwanted side effects in the breastfeedinginfant, medications should be used at the lowesteffective doseand for the shortest duration. Generally, the same medications used during pregnancy can be continued after delivery and while breastfeeding. An exception is an aspirin which may cause bleeding problems and Reye's syndrome in thenursingbaby and should therefore be avoided. Mothers who must take medications should also consider not breastfeeding.

Divalproex (Depakote ER,丙戊酸钠洒胶囊, Depakote) should not be used in patients with liver orpancreaticdisease.

来源:
American Headache Society
Annals ofAllergy,Asthma, andImmunology
Food and Drug Administration
Kaiser Permanente Drug Encyclopedia
Migraine Research Foundation
The Migraine Trust
National MigraineAssociation
National Headache Foundation
“Headache in pregnant andpostpartumwomen.” UpToDate.
“Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.”Neurology
WebMD