Category Archives: Headache & Migraine

Preventive Treatment for Migraine

Migraine is a common episodic headache disorder characterized by attacks that consist of various combinations of headache and neurologie, gastrointestinal, and autonomie symptoms. It has a one-year prevalence of approximately 18% in women, 6% in men, and 4% in children. The second edition of the International Classification of Headache Disorders (ICHD-2) subclassifies migraine into migraine… Read More »

Specific Migraine-Preventive Agents

β-Adrenergic Blockers β-blockers, the most widely used class of drugs in prophylactic migraine treatment, are approximately 50% effective in producing a greater than 50% reduction in attack frequency. Rabkin et al. serendipitously discovered propranolol’s effectiveness in headache treatment in patients who were being treated for angina. The Agency for Healthcare Policy and Research (AHCPR) Technical… Read More »

Specific Migraine-Preventive Agents: Other Drugs

Alpha Antagonists The U.S. Headache Consortium Guidelines and the AHCPR Technical Review included 17 controlled trials of a2 agonists for the prevention of migraine: 16 of clonidine () and one of guanfacine. The evidence from these trials suggests that a2 agonists are minimally, and not conclusively, efficacious. Of the 11 placebo-controlled trials of clonidine, 3… Read More »

Specific Migraine-Preventive Agents: Serotonin Antagonists

The antiserotonin, migraine-preventive drugs are potent 5-HT2B- and 5-HT2C-receptor antagonists, whereas metachlorophenyl piperazine (mCPP), a 5-HT2B- and 5-HT2C-receptor agonist, induces migraine in susceptible individuals. Methysergide, cyproheptadine, and pizotifen, effective migraine prophylactic drugs, are 5-HT2B-and 5-HT2C-receptor antagonists, whereas ketanserin, a selective 5-HT2A- and a poor 5-HT2B- and 5-HT2C-receptor antagonist, is not. mCPP, a major metabolite of… Read More »

Specific Migraine-Preventive Agents: Anticonvulsants

Anticonvulsant medication is increasingly recommended for migraine prevention, because it was proved to be effective by placebo-controlled, double-blind trials. With the exceptions of valproic acid, topiramate, and zonisamide, anticonvulsants may interfere substantially with the efficacy of oral contraceptives. Nine controlled trials of five different anticonvulsants were included in the AHCPR Technical Report. Carbamazepine The only… Read More »

Specific Migraine-Preventive Agents: Calcium-Channel Antagonists

Calcium, in combination with a calcium-binding protein such as calmodulin or troponin, regulates many functions, including muscle contraction, neurotransmitter and hormone release, and enzyme activity. Its extracellular concentration is high; its intracellular free concentration is 10,000-fold smaller. The concentration gradient is established by membrane pumps and the intracellular sequestering of free calcium. When stimulated, the… Read More »

Specific Migraine-Preventive Agents: Antidepressants

Antidepressants consist of a number of different classes of drugs with different mechanisms of action. Only tricyclic antidepressants (TCAs) have proven efncacy in migraine; we cover the newer components for completeness and reader interest. Mechanism of Action TCAs, selective serotonin-reuptake inhibitors (SSRIs), and serotonin NE-reuptake inhibitors increase synaptic NE or serotonin (5-HT) by inhibiting high-affinity… Read More »