Saturday, 7 December 2013

Menstrual Migraines Treatments in conventional medicine

Menstrual Migraines is a hormone related headaches happened in the before, during or immediately after the period, or during ovulation as a result of the levels of estrogen and progesterone fluctuations in the menstrual cycle.
Treatments in conventional medicine
 A. Types of therapy (Non medication treatment)
1. Hormone therapies
a. Estradiol supplements
In a review of the data from 35 women were available for a paired analysis. Percutaneous estradiol was associated with a 22% reduction in migraine days (RR 0.78, 95% CI 0.62 to 0.99, p = 0.04); these migraines were less severe and less likely to be associated with nausea. This was, however, followed by a 40% increase in migraine in the 5 days following estradiol vs placebo (RR 1.40, 95% CI 1.03 to 1.92, p = 0.03)(9)
b. Estrogen therapy
Falling estrogen levels or estrogen withdrawal after periods of sustained higher levels can trigger migraine, and hormonally associated migraine is a specific clinical entity. It is important to diagnose the type of migraine, considering the fact that a decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.(11)
c. Combined oral contraceptives
In a study of women ages 20 to 35 years (n = 60) suffering from pure menstrual migraine without aura, conducted by University of Siena, showed a significant reduction in the intensity and duration of menstrual migraine, patients in group B (24/4 COC) reported a significant reduction in the intensity and a shorter duration of their menstrual migraine, compared with group A (21/7 COC)(12)

3. Biofeedback 
There are a report that the effects of biofeedback on patients suffering predominantly from either menstrual or nonmenstrual migraine is just as effective in reducing menstrual migraine as it is in reducing nonmenstrual migraine.(13)
4. Psychological and behavioral therapies
researchers at the IWK-Grace Health Centre suggested that Biofeedback, relaxation, and stress-coping treatments can be effective for the majority of migraine sufferers and treatment effects are reliably maintained for periods of at least one year, but little is known about the mechanism behind the efficacy of psychological treatments(14)

3. Etc.

B. Medication
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 mestrual migraine. including
1. Triptan
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). Other study found that treatment of up to 12 perimenstrual periods over a 12- to 15-month period, the safety and tolerability of frovatriptan for short-term prevention of menstrual migraine was similar to that observed with acute use of triptans. Adverse events were generally mild or moderate in severity, there was no evidence of an increased risk of cardiovascular adverse events relative to acute treatment, and rebound headache was not evident. A short-term regimen with frovatriptan presents a safe and viable treatment option for preventing predictable migraine such as menstrual migraine(8)
In other study,  Zolmitriptan 2.5 mg oral tablet is effective and well tolerated as a short-term preventative therapy for menstrual migraine attacks(10)
 b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
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.

2. Ergotamine
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)

4. Etc.

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.
b.4. 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
4. Etc.

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
b.5. Etc.
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.

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