Migraine
Treatment
Triptans
Triptans, structurally related to 5-HT, are selective and potent 5-HT1B/1D agonists. 5-HT1B/1D receptors are inhibitory in nature and are primarily found presynaptically within the CNS, especially in regions of blood vessels and the trigeminal nerve. Thus, administration of these agonists acts to prevent activity of 5-HT neurones on which they are located and also post-synaptic stimulation of connected neurones as a result of this activity. These receptors are, like most 5-HT receptors, G Protein coupled, causing their secondary messenger cAMP to decrease in concentration. Notable agonists of this nature, which are used to treat migraine, are sumatriptan, zolmitriptan, rizatriptan and naratriptan.
Ergotamines
Ergotamines are serotonergic vasoconstrictors and are sometimes used in the treatment of migraine. They work to counteract the vasodilation that is a notable cause of many migraine symptoms. It’s use, however, is limited by poor and erratic absorption, some common side-effects and also the possibility of a rebound headache. It’s use therefore, is strictly limited to only once every four days.
Anti-Epileptics
Anti-Epileptics of the barbiturate family have also been used to treat migraine. They are only given as a treatment if in combination with aspirin or acetaminophen, with optional caffeine additions. These are used as non-specific treatments for both migraine and tension-type headaches. They have no analgesic action but they do produce a sedative effect they may alleviate associated anxiety and also decrease neuronal excitation. The caffeine acts as a dose-dependent analgesic adjuvant.
Analgesics
Analgesics, such as aspirin, NSAIDS and ibuprofen, may commonly be used to provide pain relief for migraine sufferers. These operate on their normal basis. NSAIDS also inhibit the COX enzymes that are crucial to the development of inflammation processes. Whilst they may go some way to providing substantial relief to sufferers the wide range of symptoms experienced are not combatted by their use.
Neurokinin Inhibitors
Neurokinin Inhibitors may be a future area for the development of migraine treatment if their involvement in the aetiology of migraine can be finalised. This may be the case with BK, CGRP, NO and Substance P if their roles can be fully established.
Diet & Lifestyle
Dietary changes can help in the management of migraine, in particular the
limitation of stimulatory substances such as MSG, cheeses etc. Also, changes
in lifestyle to avoid frequent stimulators of migraine, such as lack of sleep,
can be key to managing migraine. These factoprs can vay considerably between
indivduals that are affected and so treatment can also vary greatly.
[8, 22,
31, 41,
51]
