Migraine_Treatment_MBBS_Presentation.pptx

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1. Treatment of Migraine MBBS-Level Teaching Presentation

2. Overview of Migraine Migraine is a chronic neurologic disorder characterized by episodic attacks of headache and associated symptoms. Treatment is divided into: • Acute (abortive) treatment • Preventive (prophylactic) therapy • Non-pharmacologic approaches • Newer therapies including CGRP antagonists and gepants.

3. Acute Migraine Treatment: Principles Goal: Rapid relief of pain and restoration of function. • Best efficacy when taken early in attack. • Choose based on severity, patient comorbidities, and previous response. • Avoid medication overuse (>10 days/month for triptans/ergots, >15 for NSAIDs).

4. Acute Treatment: Mild to Moderate Attacks 1. NSAIDs (e.g., ibuprofen, naproxen, diclofenac) 2. Acetaminophen (paracetamol) 3. Combination analgesics (e.g., paracetamol + caffeine) 4. Antiemetics (e.g., metoclopramide) for associated nausea.

5. Acute Treatment: Moderate to Severe Attacks 1. Triptans (e.g., sumatriptan, rizatriptan, zolmitriptan) • Serotonin (5-HT1B/1D) receptor agonists • CI: cardiovascular disease, hemiplegic migraine 2. Ergotamines (e.g., ergotamine tartrate, DHE) • Less used due to side effects, narrow therapeutic index.

6. Preventive Therapy: Indications Consider when: • ≥4 headache days/month • Significant disability • Contraindication or failure of acute treatment • Patient preference or medication overuse

7. Preventive Therapy: Medications 1. Beta blockers (propranolol, metoprolol) 2. Antiepileptics (topiramate, valproate) 3. Tricyclics (amitriptyline) 4. Calcium channel blockers (flunarizine) 5. Botulinum toxin A (for chronic migraine)

8. Non-Pharmacologic Approaches • Sleep hygiene and regular meals • Avoidance of known triggers • Biofeedback and cognitive behavioral therapy • Stress management techniques • Acupuncture (adjunctive benefit in some patients)

9. Newer Drugs for Migraine 1. Gepants: CGRP receptor antagonists (ubrogepant, rimegepant) 2. CGRP monoclonal antibodies: • Erenumab (receptor) • Fremanezumab, galcanezumab (ligand) • Used in patients with refractory or frequent migraine.

10. Stepwise Approach to Treatment 1. Assess severity and disability 2. Start with appropriate acute treatment 3. If frequent or disabling, consider prevention 4. Monitor response and adjust 5. Educate patient about triggers and adherence

11. Summary • Migraine treatment involves acute and preventive strategies. • Triptans and NSAIDs are mainstays of acute therapy. • Preventive drugs chosen based on comorbidities and tolerability. • Newer agents provide options for refractory cases. • Non-drug approaches enhance long-term outcomes.