Migraines - Pathophysiology & Treatment (Described Concisely)

our topic today is migraine headaches migraines are generally identified as headaches that affect one side of the head are pulsating in nature and can last anywhere from two to 72 hours symptoms often associated with migraines may include nausea vomiting and sensitivity to light sound or smell the pain and associated symptoms of migraines are often made worse by physical activity migraine headaches are more common in women than in men and tend to run in families there are two main types of migraines those preceded by what is known as an aura and those without aura migraines without aura are more common and make up about 85% of cases they may be preceded by fatigue and irritability an RA is a sensory experience that precedes the headache R is typically consists of visual symptoms such as flickering lights spots or loss of vision sensory symptoms may include needle sensations or numbness and problems with speech or other neurological symptoms possible triggers of migraines include increased stress changes in sleep patterns and fluctuation of estrogen during menstrual periods dietary sources such as monosodium glutamate age cheese and chocolate may also increase the risk for migraine headaches some non pharmacologic measures that can be taken to prevent migraines include avoidance of triggers also maintaining regular sleep patterns is important so be consistent with getting up times and going to bed times during an attack retiring to a darkened room also helps to alleviate symptoms during a migraine the trigeminal nerve cranial nerve 5 becomes activated this results in the release of neuro peptides from cranial nerve 5 the neuro peptides include vasoactive inhibitory peptide or VIP substance P & calcitonin gene related peptide or see GRP these neural peptides cause painful neurogenic inflammation in the meningeal vasculature causing mass cell degranulation plasma protein extravasation basal dilation and activation of nociceptors all which contribute to the migraine headache these neural peptides play an important role in trigeminal vascular pain transmission in migraine headaches pharmacologic treatment of acute migraines using a goths and triptans act to decrease or inhibit the release of neural peptides from cranial nerve five this action will decrease the inflammation neuropeptides caused including decreasing cerebral Veysel dilation and decreasing pain ferguson triptans caused this decreased note peptide release by activating v h t1 b + 5 h t1 d presynaptic auto receptors when these auto receptors are stimulated the release of neuropeptides is inhibited this in turn causes a decrease in cerebral vasospasm B receptors on cerebral vessels and oregon's and triptans stimulating these causes vasoconstriction taking away the vasodilation associated with migraines ragazze also activate alpha one receptors on cerebral vessels causing further vasoconstriction ragazze may be used in the acute treatment of migraines and include da Hyder or gotta mean and/or gotta mean overall da header or gotta mean is more effective at relieving migraines as mentioned or Goths act as agonist at 5 h t1 b and v HT 1 D receptors leading to less release of neuropeptides and vasoconstriction they also are partial agonist at alpha 1 receptors causing further vasoconstriction the header ergotamine is available for intravenous intramuscular and subcutaneous as well as intranasal administration or gotta mean maybe given sublingually our guy should not be using those that are pregnant or 'the cardio disease hypertension liver or kidney disease triptans r5h t1 b and v HT 1d agonist their mechanism involves causing vasoconstriction inhibiting neuropeptide release and inhibiting pain pathways in the brain stem medications in this class include sumatriptan Zoma tripped n rise a trip ten Ella tripped an allotrope ten narrative ten and fro VII trip ten sumatriptan can be given subcutaneously by nasal powder or nasal spray and orally Zoma triptans can be giving given nasally or orally the rests are only given orally all tripped hands have been shown to be safe and effective for most patients but narrow triptans and fro the triptans have a slower onset and appear to be the least efficacious at relieving acute migraines remember that patient response varies if one trip ten doesn't work another maybe try it it's best to take trip tans early when symptoms first start and don't use trip tans for more than ten days out of the month in order to avoid overuse headaches trip tents should be avoided in those with certain conditions like hemiplegic or basilar migraine ischemic stroke or heart disease variant angina and controlled hypertension and pregnancy always consider drug drug interactions that may occur a newer class of migraine medications are the C GRP antagonists remember that C GRP was one of the neuro peptides released from the trigeminal nerve and plays an important role in trigeminal vascular pain transmission and migraines these drugs antagonize the GRP receptors or bind to the C GRP ligand blocking the effects of C GRP air a new mAb from as a noob AB and gal can assume AB are given subcutaneously and Epton assume AB is given IV and these are used to prevent migraines ramanga pent who brogre pent are given orally and are used for acute migraine attacks thanks for watching

Channel: PhysioPathoPharmaco

Views: 182,097

Keywords: cgrp antagonist, migraines, triptans for migraine, triptans mechanism of action, migraine treatment, migraine pathophysiology, cgrp inhibitor, cgrp mechanism

Id: bvS646hm5v8

Length: 6min 58sec (418 seconds)

Published: Fri Apr 10 2020