#Amopic migraine medication trial

Naratriptan: PO tablet with standard dosages of 2.5 and 1 mg has a sulfa group

Sumatriptan: PO tablet with standard dosages of 100, 50, and 25 mg also available parenteral (though IV contraindicated because of its potential to cause vasospasm)Įletriptan: PO tablet with standard dosages of 40 and 20 mg contraindicated in patients with renal failure, arrhythmias, and heart failure The proposed mechanism of action involves binding postsynaptic 5-HT1B receptors on the smooth muscle cells of blood vessels and presynaptic 5-HT1D receptors on the trigeminal nerve terminals and dorsal horn neurons. Triptans are serotonin-receptor agonists with a high affinity for 5-HT1B and 5-HT1D receptors, and variable affinity for 5-HT1F receptors. They are often therapeutic choices if other therapies have failed (i.e., NSAID, acetaminophen) or if the headache is severe. Triptans are significantly more expensive than NSAIDs as a class. They include sumatriptan, eletriptan, naratriptan, zolmitriptan, rizatriptan, frovatriptan, and almotriptan. Seven triptans have approval from the FDA and marketed for acute treatment of migraines.

Warnings include those with significant cardiovascular disease, renal insufficiency, gastrointestinal erosive disorders, bleeding diathesis, and those taking warfarin.įor acetaminophen, contraindications include hypersensitivity reactions and severe active liver disease. In addition to NSAID hypersensitivity reaction, another agreed-upon absolute contraindication is for those in the preoperative period of coronary artery bypass graft surgery. After higher doses or prolonged duration of taking acetaminophen, hepatotoxicity, and nephrotoxicity (less common) can occur. Other less common symptoms include easy bruising, pruritus, rash, hypersensitivity response in asthmatics, gastritis, esophagitis, GI bleeding, renal failure, hepatic impairment, and cardiovascular events.īesides allergic reactions, no serious side effects have been observed with acetaminophen when taken in appropriate dosages. The most common adverse effects of NSAIDs are GI symptoms, which include dyspepsia, abdominal burning or discomfort, and diarrhea. Ketorolac: Parenteral dosing with standard dosages of 30 to 60 mg treatment dose of 30 to 60 mg It also may affect opioidergic systems, eicosanoid systems, and the nitric oxide-containing pathways. Aspirin acts as an irreversible COX I and 2 inhibitor.Īlthough not entirely understood, the current thought is that acetaminophen affects central processes, such as positive effects on the serotonergic descending inhibitory pathways. The NSAIDs that inhibit prostaglandin E2 synthesis are effective in treating acute migraine attacks. NSAIDs reversibly inhibit cyclooxygenase (COX) 1 and 2. NSAIDs include aspirin, naproxen, ibuprofen, tolfenamic acid, diclofenac, piroxicam, ketoprofen, and ketorolac.Īcetaminophen and the combination of acetaminophen/aspirin/caffeine have also demonstrated consistent evidence of efficacy for acute migraine.

#Amopic migraine medication trial

Ibuprofen, naproxen sodium, acetylsalicylic acid (ASA), and diclofenac potassium all have double-blinded randomized controlled trial evidence for efficacy that has analysis in systematic reviews. Non-steroidal anti-inflammatory drugs (NSAIDs) are mainstay choices and have the greatest strength of evidence. Anti-inflammatories (NSAIDs and Acetaminophen)