Migraine
A recurrent headache that is usually throbbing and typically affects one side of the head. Some attacks are preceded by a warning (aura) consisting of visual disturbances and numbness and/or weakness of the limbs.
The headache is often accompanied by nausea and vomiting. Migraine may be precipitated or exacerbated by certain foods (such as cheese or chocolate), red wine, or stress. It is thought to be caused by changes in the blood vessels around the brain and eyes and in the scalp, which constrict and then become overdilated.
A variety of drugs is available for the treatment of migraine attacks. Analgesics, for pain relief, usually contain aspirin, paracetamol, and/or codeine; if these are ineffective, tolfenamic acid (an NSAID) may be tried. For people who fail to respond to these analgesics, 5HT1 agonists, such as sumatriptan or zolmitriptan,
are the recommended treatment for an acute attack. They act by reversing the overdilatation of the blood vessels in the brain. Ergotamine tartrate also constricts blood vessels, but it is less selective in this action than the 5HT1 agonists and has more severe side effects.
Antiemetics, such as metoclopramide, cyclizine, or buclizine hydrochloride, may be required to relieve the nausea and vomiting associated with a migraine headache. These may be used alone or combined with an analgesic.
For people who experience frequent migraine attacks (more than one a month), a preventive approach is needed. The drugs used for this purpose include beta blocker (such as propranolol, metoprolol, nadolol, and timolol), the antihistamines
pizotifen and cyproheptadine (which antagonize the effects of serotonin), and tricyclic antidepressants (such as amitriptyline). Since long-term treatment with these drugs is not advisable, the patient's condition
should be assessed at six-monthly intervals to see if treatment needs to be continued. Some individuals benefit from the herbal remedy feverfew.
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Depakote
