MANAGAMENT OF MIGRAINE

Posted by e-Medical PPT Monday, August 9, 2010
Migraine is one of the common causes of recurrent headaches.According to IHS, migraine constitutes 16% of primary headaches.Migraine afflicts 10-20% of the general population.More than 2/3 of migraine sufferers either have never consulted a doctor or have stopped doing so Migraine is underdiagnosed and undertreated.Migraine greatly affects quality of life. The WHO ranks migraine among the world’s most disabling medical illnesses.



THE TREATMENT APPROACH TO MIGRAINE
1.Non-pharmacological treatment
  • Identification of triggers
  • Meditation
  • Relaxation training
  • Psychotherapy
2.Pharmacotherapy
Abortive therapy
  • non-specific Aspirin,Paracetamol,Ibuprofen,Diclofenac and Naproxen
  • specific Ergot alkaloids and 5-HT receptor agonists
Preventive therapy - Betablockers,Calcium Channel Blockers,TCAs and SSRIs

WHEN IS PROPHYLAXIS INDICATED?
According to the US Headache Consortium Guidelines,indications for preventive treatment include:
  • Patients who have very frequent headaches (more than 2 per week)
  • Attack duration is more than 48 hours
  • Headache severity is extreme
  • Migraine attacks are accompanied by prolonged aura
  • Unacceptable adverse effects occur with acute migraine treatment
  • Contraindication to acute treatment
  • Migraine substantially interferes with the patient’s daily routine, despite acute treatment
  • Special circumstances such as hemiplegic migraine or attacks with a risk of permanent neurologic injury
  • Patient preference

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