Antimigraine

Migraine is characterized by episodes of throbbing headache with a range of associated symptoms such as nausea, vomiting and photophobia.

Nociceptive trigeminal nerve fibers are stimulated. This is probably due to the release of vasoactive peptides from the sensory nerve endings that innervate the meningeal vessels. The released agents lead to the dilation of these vessels, the development of perivascular inflammation and nerve irritation. Hand in hand with these changes are enhanced sensory sensations that are perceived as pain (allodynia).

Pharmacotherapy of migraine is either abortive or preventive. Acute (abortive) treatment of seizures is non-specific (consists of administration of analgesics) and specific (triptans, ergotamines). Prophylactic migraine treatment can be chronic or episodic.

See the migraine page for more detailed information .

Treatment of an acute migraine attack
We distinguish between specific (triptans and ergot alkaloids) and non-specific treatment.

Non-specific treatment (also effective for other headaches) includes non-opioid analgesics ( acetylsalicylic acid, paracetamol , non-steroidal anti-inflammatory drugs - most often ibuprofen or indomethacin suppositories). As a rule, single-component preparations are sufficient, however, there are also combined preparations on the market (e.g. paracetamol + caffeine). Treatment with opioid analgesics is not very suitable because they worsen nausea and vomiting. Corticosteroids are indicated for a protracted attack or for so-called status migrainus. In some cases, antipsychotics or antiemetics (most often prokinetics, i.e. domperidone, metoclopramide) are part of the treatment.

Triptans [ edit | edit source ]
These are agonists of serotonin 5-HT1B/1D receptors. They cause constriction of dilated cerebral vessels and prevent fluid extravasation. The result is a reduction in irritation of the perivascular fibers of the trigeminal nerve and an inhibition of the release of neuropeptides.

Side effects include fatigue, drowsiness, nausea, dizziness, chest pain (reminiscent of CHD), serotonin syndrome, and hot flashes. They are contraindicated in patients with CHD, uncompensated arterial hypertension, in patients with a history of central cerebrovascular accident and also in pregnancy.

They are indicated only for migraine and cluster headache. They are suitable as first-line treatment in patients in whom single or combined analgesics have not provided sufficient relief.

Representatives: sumatriptan, almotriptan, eletriptan, frovatriptan, naratriptan and others

Ergot alkaloids [ edit | edit source ]
They have a similar mechanism of action to triptans, but also act on other subtypes of serotonin receptors as well as adrenergic and dopaminergic receptors. They therefore have more side effects and are therefore no longer used much.

Representatives: dihydroergotamine, ergotamine.

Prophylactic treatment of seizures
We indicate this treatment for patients who suffer from more than 3 migraine attacks per month and meet other relevant criteria. Monotherapy is preferred. Treatment aims to reduce the frequency, duration and severity of seizures. It can be given for several months to years.


 * Tricyclic antidepressants - inhibit serotonin 5-HT2 receptors (amitriptyline, nortriptyline)
 * Anticonvulsants – increase GABA neurotransmission and have a strong inhibitory effect on trigeminovascular nociceptive neurons (topiramate, valproate)
 * Beta-blockers - dampen the effect of stress, prevent the development of sterile inflammation (metoprolol, propranolol)
 * Calcium channel blockers - act against vasoconstriction of cerebral vessels, inhibit the synthesis of prostaglandins and leukotrienes (verapamil)
 * Botulinum toxin A into small muscles frontally and temporally and in the glabella area
 * Anti-CGRP – calcitonin gene-related peptide monoclonal antibodies (biological drugs for migraine prophylaxis)

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