F. Treatments in conventional medicine
F. A. Types of therapy (Non medication treatment)
1. Biofeedback and Cognitive-behavioral therapy
Some studies find that following sequence: blood-volume-pulse biofeedback followed by cognitive behavioral therapy (Group I) or were given the treatment in reverse order (Group II). The application of biofeedback helps the patient to recognize the influence of thoughts and emotions on bodily reactions and therefore prepares the way for successful cognitive treatment.(F.A.1)
2. Relaxation training/thermal biofeedback (RTB)
Relaxation therapy is a technique helped to enhance the relaxation response with an aim to relieve stress, control anxiety, improve sleep, and have a better quality of life in general. In the study conducted by University of Pittsburgh Medical Center, found that 41.3% of patient reported a significant headache reduction in relaxation training/thermal biofeedback (RTB).
F. B. Medication
F.B.A. Medication to relieve acute migraine pain
Depending to the severity of the disease, acute attacks may be best prescribed by a prescription version of an NSAID, of which have a potent vasoconstricting action (constricting blood vessels) and patients are instructed to take them during or at the onset of a migraine. including
a. Triptan are a family of tryptamine-based drugs used in the treatment of migraine headache and cluster headache. In the comparison of subcutaneous sumatriptan and oral administration formulation, subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated.(F.B.A.1)
b. Side effects of Triptan are not limit to
b.2. Dry mouth
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.
Ergotamine has been used to treat migraine for a century and is still considered to be the most effective therapeutic agent for acute attacks andt good responses of the medication are associated with plasma concentrations of 0.2 ng/ml or above within one hour of administration.
In the same study, researchers also emphasized the principal adverse effects of ergotamine include nausea, vomiting, weakness, muscle pains, paraesthesiae and coldness of the extremities and suggested dosage must therefore be limited to no more than 10mg per week to minimise toxicity.(F.B.A.2)
3. The oral calcitonine gene-related peptide antagonist telcagepant
In a recent study conducted by University of Liège, in comparison of the oral calcitonine gene-related peptide antagonist telcagepant(CGRP) and triptans, found that its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Researchers also said that the drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.(F.B.A.3)
F.B.B. Medication to prevent migraine pain
Medication used to prevent migraine pain are normal prescribed for patient who are experience frequent migraine attacks, severe side effects from acute treatment drugs or ineffectiveness of acute treatment drugs and together with behavioral therapy and lifestyle adjustments.
1. Beta-blocker (usually propranolol [Inderal] or timolol [Blocadren])
a. Beta-blocker are also known as beta-adrenergic blocking agents, use to block norepinephrine and epinephrine from binding to beta receptors on nerves to prevent migraine headache. Some researchers suggested that the addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment.(F.B.B.1)
b. Side effects are not limit to
b.1. Beta-blocker may interact with other medicines, such as thioridazine, chlorpromazine, etc.
b.2. Most common side effects include dastrointestional discomfort such as stomach cramps, nausea and vomiting.
b.3. The medication may also increase nervous symptoms, including headache, depression, confusion, dizziness, etc.
2. Anticonvulsants (usually divalproex [Depakote] or topiramate [Topamax])
a. Anticonvulsants or anti seizure are medication used to treat epileptic seizures, bipolar disorder as mood stabilizers and neuropathic pain. In the study conducted by Department of Neurology, Canisius Wilhelmina Ziekenhuis, anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by > or = 50% relative to placebo.(F.B.B.2)
b. Side Effects are not limit to
1. The medication may also increase central nervous symptoms such as dizziness, drowsiness, unsteadiness, feeling dull difficulty concentrating, focusing, mood swing, etc.
2. The medicine may cause gastrointestinal discomfort such as nausea, and vomiting.
3. Other side effects include liver or kidney damage and decrease the amount of platelets in your blood
3. Tricyclic antidepressants (usually amitriptyline [Elavil])
a. Tricyclic antidepressants are also known as cyclic antidepressants, a chemical compound used to treat depression by affecting chemical messengers, neurotransmitters, in the brain. In the study conducted by Ohio University, Athens, found that amitriptyline is more effective than placebo for migraine and tension headache. Amitriptyline also seems to be more effective than serotonin reuptake inhibitors, although few direct comparisons are available.(F.B.B.3)
b. Side Effects are not limit to
b.1. The medication may cause central nervous symptoms, such as blurred vision, confusion, drowsiness, etc.
b.2. Loss of sexual desire
b.3. Lowered blood pressure
b.4. Tremors and sweating
The doses and duration is depending to the nature of the migraine, but in general, patient started the medication at a low dose, and then gradually increased.
F.B.C. Medication for children
According to the recommendation of The American Academy of Neurologys practice guidelines
1. children Under 12 years old
a. Ibuprofen (Advil)
a.1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used as as an analgesic for relief of symptoms pain as aresult of inflammation of certain diseases. In adult, researchers found that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing (F.B.C.1). Children should reduce the amount of medication according to the guideline.
a.2. Side Effects are not limit to
a.2.1. Common side effects include nausea, dyspepsia, gastrointestinal ulceration/bleeding, headache, dizziness, rash, etc.
a.2.2. Less common side effects include esophageal ulceration, heart failure, renal impairment, confusion, etc.
b.1. Acetaminophen is a pain reliever to treat moderate to moderately-severe pain. Some researchers suggested that Tramadol/acetaminophen reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache(F.B.C.2)
b.2. Side effects are not limit to
b.2.1. Common side effects include nausea, vomiting, sweating, diarrhea, irritability, etc.
b.2.2. Less common side effects include liver or kidney failure, heart problems, seizures, etc.
2. Children 12 and older
a. Sumaptriptan (Imitrex) is a triptan sulfa drug used for the treatment of migraine headaches. some researchers found that nasal sumatriptan may be effective in aborting migraine in young children (aged 5 to 12 years). It also suggests that there may be subgroups for which it works well. This information suggests that double-blind, placebo-controlled studies are necessary to determine the overall effectiveness of nasal sumatriptan in this age group(F.B.C.3)
b. Side effects are not limit to
b.1. Most common side effects include flushing, sensations, weakness, drowsiness, or dizziness, etc.
b.2. Less common side effects include confusion, slurred speech, fainting, fast/irregular heartbeat, vision changes, etc.
For more information of the side effects of Imitrex, please read http://us.gsk.com/products/assets/us_imitrex_injection.pdf
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