Role of Nasal & Parenteral 5-HT1 Agonists in Migraine Management
The nasal (as nasal spray) 5-HT1 agonists, which are available for treatment or management of migraine headache, are dihydroergotamine, sumatriptan, zolmitriptan etc. and parenteral (as injection) 5-HT1 agonists are dihydroergotamine and sumatriptan.
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Role of Oral 5-HT1 Agonists in Migraine Management
The role of 5-HT1 agonist drugs is very important in management of migraine headache, because stimulation of 5-HT1B/1D receptors can stop an acute migraine attack. 5-HT1B/1D receptor agonists can be selective and non selective type. Ergotamine and dihydro-ergotamine are nonselective5-HT1B/1D receptor agonists, while the triptans are selective 5-HT1B/1D receptor agonists. Sumatriptan, naratriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan etc. are commonly known as triptans and they are commonly used in treatment of migraine.
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Management of Acute Migraine Attacks
The most important aspect of pharmacological (drug) therapy of migraine is the judicious use of the many drugs that are effective in treating migraine. The choice of the drugs (best or optimal regimen) for a given patient depends on a number of factors and the most important of which is the severity of the attack (the severity of migraine is measured or calculated by “The Migraine Disability Assessment Score” or MIDAS). Mild to moderate migraine attacks can usually be managed by oral agents (simple analgesics, NSAIDs, 5-HT1 (hydroxy tryptamine) Agonists, Dopamine Antagonists and certain other drugs) and the average efficacy rate of these oral anti migraine agents is 50–70%. There may be necessity of parenteral drugs in case of severe attacks of migraine headache.
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Drugs Used in Migraine
There are many drugs available for treatment (management) of migraine, which are effective in aborting attacks of migraine. What is important is the judicious use of these drugs in patients with migraine. There can be many factors (the most important of which is the severity of the attack) which determine the choice of drugs in migraine. Mild migraine attacks can generally be managed by oral agents (the average efficacy rate of oral agents are approximately 50% to 70%), but the severe migraine attacks may require parenteral therapy. The following drugs are available for treatment of migraine headache:
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Non Drug Management of Migraine
Some patients with migraine headache can be managed with certain non pharmacological (non drug management) approaches. It is always better to manage any disease if it can be managed without need of any medication, as all medicines have some side effects (may be minor and non significant) and some of the side effects may be major, which itself become problematic for the patient. Since some patients of migraine headache can be managed without any medication it is always advisable to try to manage patients with migraine (except patients with acute severe migraine) without any drug. If migraine headache is not very serious all the patients of migraine should be tried with non pharmacological approaches available for management of migraine headache.
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General Principles of Migraine Management
There are few important aspects for management of migraine headache, which should be kept in mind while treating (managing) a patient with migraine headache. The most important aspect in the management of migraine headache is educating the patient about the reality of migraine headache. It is generally helpful to educate the patient about migraine and to make the patient understand that migraine is an inherited tendency to headache and that migraine can be modified and controlled by lifestyle modifications (adjustments) and medications, but it cannot be eradicated or cured. It is also important to educate the patient that migraine is not associated with serious or life-threatening illnesses, except in some occasions in women who are on oral estrogens or on oral contraceptives.
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How to Asses Severity of Migraine?
After diagnosis of migraine headache is confirmed the assessment of severity of migraine headache is very important. The assessment of severity of migraine headache is generally done by asking the patient to answer a set of questionnaire known as “The Migraine Disability Assessment Score (MIDAS)”. This (The Migraine Disability Assessment Score) is a well-validated, easy-to-use tool which is most commonly used and very practicable. The following are the MIDAS questionnaire:
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How Migraine is Diagnosed
To diagnose migraine a high index of suspicion is required at the beginning. There are certain characteristic clinical features in migraine headache. In migraine there is an aura (the migraine aura), which makes the patient understand the disease. The migraine aura, consist of visual disturbances with flashing lights or zigzag lines moving across the visual field or sometimes certain neurological symptoms.
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Know About Migraine
Migraine is a type of primary headache. Primary headache is the type of headache, where headache and associated symptoms occur in the absence of any exogenous cause. Some examples of primary headache are migraine headache, tension-type headache, and cluster headache. Migraine is a very common clinical problem which afflicts approximately 15% of women and 6% of men. Migraine is the second most common cause of headache. Migraine headache is episodic in nature and is associated with certain features such as sensitivity to light, sound, or movement. Light, sound, movements are the activating factors of migraine and these are known as activators (also known as “triggers”). The specialty of migraine is its possibility of identification by a layman by its activators or “triggers”.
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