On drug treatment of migraine

[Abstract] Objective To study the drug treatment of migraine. Methods for the treatment of pain, sedation, improvement of vascular function, etc, the medicine can increase the pain threshold of patients can be sedation, analgesia, improve cerebral blood flow, which in turn has The role of the treatment of migraine. Therefore the treatment of migraine associated with traditional Chinese medicine can achieve better results. Conclusion Integrated Traditional and Western therapies to treat the disease, efficacy, low recurrence rate, worthy of clinical application.

[Keywords: migraine drugs
Migraine is a recurrent vascular headache, the pain was on one side or both sides, often accompanied by nausea and vomiting. A few atypical cases before the onset of visual, sensory, motor and so threatened, and family history.

(A) of the commonly used drugs
1. Ergotamine preparations ergotamine and caffeine, ergotamine tartrate injection.

2. Sedative analgesics, diazepam.

3. Non-steroidal anti-inflammatory drugs (NSAIDs) aspirin, acetaminophen, naproxen, ibuprofen, indomethacin.

4.5-HT receptor agonist, sumatriptan, Zuomi Ge, pizotifen, methyl lysergic acid amide.

5. Steroid prednisone, dexamethasone.

6.β blockers propranolol, metoprolol.

7. Anticonvulsant valproate, phenytoin.

8. Calcium antagonist nimodipine, flunarizine.

9. Antidepressants fluoxetine, amitriptyline, Diane God.

10. Magnesium sulfate preparations.

11. Dopamine antagonist metoclopramide (metoclopramide).

12. Anesthetic lidocaine, Paiti set.

(B) the choice of treatment
1. The treatment of acute attack
(1) pain medicine: mild to moderate migraine, various types of analgesics used, such as APC, to the pain tablets (Cable secret pain), intense pain, tearing, dipyrone, ibuprofen, naproxen and so on. General analgesic effect better, but frequent attacks often take the effect of these drugs will become increasingly worse.

(2), ergotamine preparations: severe, 5-HT receptor modulators available agents, the most commonly used ergotamine preparations, is a strong vasoconstrictor. Ergotamine and caffeine used in the clinic 1 to 2 tablets (per tablet of ergotamine 1mg, caffeine 100mg), in the aura of headache or early oral administration, such as headaches more than once every 0.5h may be a service, but not more than three daily, weekly total no more than 10 films. nausea, vomiting and other gastrointestinal symptoms can be injected ergotamine tartrate, each 0.5 ~ 1mg, coronary heart disease, pregnancy is disabled. using this medicine Note: ① the drug to be taken as early as possible, if the other headache is severe and accompanied by vomiting not already taking, ② nausea, vomiting, numbness of the limbs, chest tightness, abdominal pain and other adverse reactions. the most common and most serious side effect is limb gangrene, ③ was hypertension, coronary heart disease, kidney disease, pregnancy, peripheral vascular disease , age over 60 years, peptic ulcer and other hanged, ④ long-term use are suddenly stopped by, there will be severe rebound headache.

(3) sumatriptan triptans (sumatriptan, Imigran British Minge): is a highly selective 5-HT1D receptor activity agent, the treatment of acute migraine attack can achieve satisfactory results quickly. Oral or subcutaneous in about 30min 10 ~ 15min after injection, onset of .100 mg / tablets, take an attack when threatened, 4h after the relapse, re taking a daily total dose of not more than three. with vomiting and other gastrointestinal symptoms can Schuma triptans 6mg subcutaneous injection. The Note: ① had a hard cardiac death, angina, uncontrolled hypertension in patients over the age of temporarily disabling .65 recommended. ② tablets should be swallowed whole tablets, the drug injection non-intravenous injection. ③ not be used with ergotamine preparations, the use of ergotamine preparations to use the drug only after 24h, 6h after using the drug only be used ergotamine preparations.

④ adverse reactions are transient injection site pain, occasional tingling, fever, flushing, dizziness, occasional fatigue and sleepiness, the individual will experience nausea, vomiting, elevated blood pressure, intermittent, mild abnormal liver function.

(4), zolmitriptan (zolmitriptan, zomig Zuomi Ge): a highly selective agonist 5-HT1B/1D. The treatment of migraine attacks, recommended oral dose of 2.5mg, the effects of medication 1h the most obvious. If symptoms persist or relapse within 24h, again taking is still effective. again separated by medication for at least 2h, 5mg dose available. But taken within 24h of total of not more than 15mg. not as a migraine preventive medication. basically the same note Shu Ma triptans.

(5) hormones: the longer period of time the so-called continuous state of migraine can be applied prednisone daily 30 ~ 40mg, or daily intramuscular injection of dexamethasone 8 ~ 16mg, used in conjunction 3d. Slow intravenous injection of 20mg of dexamethasone , 1h the symptoms was 72%. also suggested that the hormone combination with the effect of ergotamine and caffeine will be better.

(6), dopamine antagonists: a metoclopramide (Metoclopramide) is used, 10mg intramuscularly. The drug itself can not reduce the pain, but enhanced the effect of analgesics and sedatives.

(7) Lidocaine: Migraine attack, using 2% lidocaine 1ml, trickle-down headaches side nostril can relieve headaches.

(8), tiapride (tiapride): a neuropsychiatric stabilizers, have anti-dopaminergic activity, can relieve a variety of pain symptoms. Use of 100mg, 3 / d. Links to Research Papers Download http: / / www.hi138.com 2. frequent migraine attacks if prevention and treatment of seizures in patients with 2 or more times per month, you need to use preventive medication.

(1) 5-HT receptor antagonists: methyl lysergic amide (methysergide) is the most effective migraine preventive medication. Taking the drug long after retroperitoneal fibrosis, pulmonary and pleural fibrosis, it is not domestic. Benzoth pyridine, from small incremental doses, 1 week before going to sleep 0.5mg, 5d each subsequent increase in 0.5mg, gradually increased to 1mg, 3 / d. The maximum daily dose of 6mg, taking no more than 6 consecutive months. Bad reaction as drowsiness, loss of appetite hyperactivity, weight gain.

(2) β-receptor blockers: propranolol (Inderal, propranolol) 40 ~ 80mg / d, divided into 4 doses. Alarmed for sinus bradycardia, severe atrioventricular block, shock, asthma, etc. disabled patients. adverse reactions were fatigue, hypotension, bradycardia, etc., should be noted. not under medication for diabetes patients.

(3) antidepressants: amitriptyline 25mg / d orally, and gradually increased to 150mg / d. other can also be used doxepin (50 ~ 75mg / d), maprotiline, fluoxetine and so on. The recent application of more more Diane is a new antidepressant God, trifluoroacetic thiophene tons (flupentixol) and tetramethyl anthracene propylamine (melitracen) of the mixture, 2 tablets a day, morning and 1 ton service or in the morning and afternoon of each one. Note: ① serious heart diseases such as myocardial infarction in the early recovery phase, bundle branch block, untreated narrow-angle glaucoma and other disabled. pregnant and lactating women with caution. ② In order to avoid the impact of sleep a day, medication should not be the last time later than 16:00. ③ with monoamine oxidase inhibitor combination can lead to high blood pressure phenomenon. ④ few adverse events were mild dry mouth, night use may affect sleep, the larger dose of treatment, there may be disturbed or even a slight tremor.

(4) anti-epileptic drugs: sodium valproate, a daily dose of 1 200mg, 2 times taken to maintain the plasma level of 700μg / L or so, to maintain 3 to 12 months. Others include phenytoin, carbamazepine, etc. .

(5) calcium antagonist: flunarizine (FNZ) 5 ~ 10mg per night 1, as after 2 months of treatment no significant improvement should be disabled. Maintenance therapy, 5mg per night 1, each weekly administration of 5d, after 6 months of treatment should be discontinued. Note: ① a history of depression, Parkinson's disease or other disabling extrapyramidal disease patients. ② adverse reactions are drowsiness and fatigue, weight gain, long-term depression by the time occasionally, the elderly are more prone to extrapyramidal symptoms , the other a rare stomach pain, insomnia, anxiety, galactorrhea, muscle pain and rash.

(6) magnesium preparations: 33% magnesium sulfate 5ml, 3 / d. After magnesium supplementation may be associated with the 5-HT, norepinephrine release was reduced and so on.

(7) ginkgo: As of sodium Health, attack immediately take 6 (240mg) or 6ml, the second day of two or 2ml, 2 / d, treatment for 1 month. Of migraine is better.

(8) Chuanxiong Tablets: 50 ~ 100mg, 3 / d. has analgesic, anti-platelet aggregation, relieve spasm and so on.

3. Menstrual migraine prevention and treatment of the current clinical drugs commonly used for menstrual migraine prevention migraine invalid or efficacy of the low. Methyl testosterone every 5 ~ 100mg, 3 / d, or testosterone propionate 25mg, each intramuscular injection of 1 day or every other day, once every 7 ~ 10d about better results. It was also treated with diuretics menstrual migraine. menstrual cramps before the 3d, the daily urinary thiophene to Hydrochlorothiazide 50mg, a total of 5d. This Law short course of treatment, side effects, better results, but it should be taken to avoid hypokalemia.

References
[1] Xiu-Juan, Zhao Ying, migraine medication. Chinese Community Doctors 2005 11.

[2] Sun Yanhua, introduction of several drug treatment of migraine. World Health Digest 2010 Volume 15 07. Links http://www.hi138.com Research Papers Download