oa SA Pharmaceutical Journal - Pathogenesis and treatment of migraine : clinical
Migraine is the second most common cause of chronic daily headache. <br>Aura is characterised by transient cerebral ischaemia and spreading depression. <br>Mitochondrial disorders, magnesium deficiency and abnormalities in calcium channels may be responsible for neuronal excitability. <br>Activation of the trigeminovascular system and brainstem centres plays a pivotal role in the genesis of headache. <br>Non-pharmacological therapy includes changes in lifestyle and avoidance of triggers. <br>Non-specific drug treatment includes simple analgesics aimed at shortening the attack and reducing severity. <br>Triptans are selective agonists of HT1B/1D receptors with 3 potential mechanisms of action: cranial vasoconstriction, peripheral neuronal inhibition and inhibition of transmission through the trigeminovascular complex. <br>The triptans have similar efficacy and safety profiles but differ in terms of tolerability. <br>Rationale for migraine prevention relates to the potential transformation into chronic persistent headaches. <br>Beta-blockers, TCAs and AEDs may all be appropriate first-line therapy.
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