MIGRAINE AND CHRONIC TENSION TYPE HEADACHE - TREATMENT MIGRAINE

MIGRAINE AND CHRONIC TENSION TYPE HEADACHE - TREATMENT

MIGRAINE

By,

Belsy Boban, Jinju Mariyam Jacob and Dinu Danty from Pharm D 5^th   and 4^th year.

Migraine is a benign and reoccurring syndrome of headache, nausea, vomiting and other symptoms neurologic dysfunction. Migraine treatment include, oral triptans which are recommended for acute treatment in patients with all severities of migraine if previous attacks have not been controlled using simple analgesics. Opioid analgesics should not be routinely used for the treatment of patients with acute migraine due to the potential for development of medication overuse headache.

•         Mild migraine( one attack per month)-  NSAID’s, Combination analgesics, Oral 5HT1 antagonists or triptans

•         Moderate migraine ( one or more attack per month)-  Oral/ nasal/ SC 5HT1 antagonists, Oral dopamine antagonists

•         \Severe  migraine (2-3 or more attack per  month)- SC, IM, or 5 HT1 agonists, IM or IV dopamine antagonists

CHRONIC TENSION TYPE HEADACHE

The International Headache Society (IHS) defines chronic tension type headache as, being bilateral and having a pressing or tightening quality of mild to moderate severity.

Non pharmacological therapy includes Psychophysiologic Therapy, Physical therapy Psychophysiologic therapy can consist of reassurance and counseling, stress management, relaxation training, and biofeedback.

               Pharmacological therapy includes Simple analgesics (alone or in combination with caffeine) and NSAIDs are effective for the acute treatment of mild to moderate tension-type headache.  Acetaminophen, aspirin, ibuprofen, naproxen, ketoprofen, Indomethacin, and ketorolac have demonstrated efficacy in placebo controlled and comparative studies. Use of butalbital and codeine combinations should be avoided when possible owing to the high potential for overuse and dependency. As with migraine headache, acute medication should be taken for episodic tension-type headache no more than 2 days per week to prevent the development of chronic tension-type headache. Preventive treatment should be considered if headache frequency (more than two per week), duration (greater than 3–4 hours), or severity results in medication overuse or substantial disability. TCAs are prescribed most often for prophylaxis, but other drugs also can be selected after consideration of co morbid medical conditions and respective side effect profiles. Injection of botulinum toxin into pericranial muscles has demonstrated efficacy in the prophylaxis of chronic tension-type headache in two recently published placebo-controlled studies

DRUG	BRAND	COMPANY	COST (/tab)
Flunarizine	Migra 5 mg	Infra	2.40
	Razin 5 mg	Shine	1.50
Propranolol	Ciplar 10 mg	Cipla	1.22
	Ciplar LA	Cipla	3.40
	Betacap plus 10 mg	Sun pharma	9
Sumatryptan	Suminat 50mg	Sun pharma	60

REFERENCE

•         Beiton J . et al., Institute of clinical systems improvement, diagnosis and treatment of headache. Http://bit.Iv/headache0113. Updated January 2013

•         Pharmacotherapy A Pathophysiologic approach by Joseph T. Dipiro, 7 th edition , page no. 1005- 1045.                                                       

•           By, Belsy Boban, Pharm D 5^th year