Pathophysiology and Pharmacology of Migraine

A type of headache with no identified underlying cause, making up roughly 90% of headache cases.

Headaches that are symptoms of a specific condition, such as a tumor or meningitis.

A type of primary headache characterized by bilateral, dull, non-pulsating pressure pain.

A type of primary headache with severe, unilateral head pain that occurs in cycles.

A type of primary headache characterized by recurring episodes of throbbing or pulsating pain, often unilateral, with potential premonitory symptoms.

Neurological symptoms that occur before the onset of a migraine headache, lasting for about 5-20 minutes.

A common premonitory symptom of migraine, where individuals experience sensitivity to sound.

Another common migraine premonitory symptom, where individuals experience sensitivity to light.

A premonitory symptom of migraine, characterized by an increased sensitivity to smells.

The primary neurotransmitter involved in the pathophysiology of migraine, playing a crucial role in vasoconstriction, vasodilation, and neurotransmitter release.

A peptide neurotransmitter released during migraine, causing potent vasodilation and mediating pain.

A strategy used to treat migraine, targeting the reduction of vasoactive neuropeptide release, specifically inhibiting CGRP or promoting vasoconstriction.

One of the major classes of drugs used to treat migraine, acting as 5-HT1B and 5-HT1D receptor agonists.

A distinct class of migraine medications that block CGRP receptors, effectively reducing its pain-inducing effects.

Drugs used to treat nausea and vomiting associated with migraine, often administered in conjunction with migraine medications.

Triptans effectively reduce migraine symptoms by constricting blood vessels, inhibiting pain signal transmission, and modulating nociceptive transmission to the brain.

Sumatriptan is metabolized exclusively by MAO, while other triptans like rizatriptan, zolmitriptan, and almotriptan have different metabolic pathways involving CYP enzymes.

Triptans are generally effective for migraine, but the ideal triptan for an individual can vary. If one triptan doesn't work, trying another may be beneficial.

Triptans should not be administered within 24 hours of other 5-HT agonists, ergotamine, or ergotamine-like compounds due to potential adverse effects.

Triptans can cause mild adverse reactions such as tingling, warmth, and dizziness. More serious side effects including chest pain or tightness may occur.

Triptans can interact with other medications, such as ergot derivatives, SSRIs, and MAO inhibitors, potentially leading to serotonin syndrome.

CYP3A4 inhibitors can increase the levels of triptans like eletriptan and almotriptan in the body, requiring adjustments in dosage.

Triptans are contraindicated in patients with cerebrovascular disease, heart conditions like angina, uncontrolled hypertension, and certain types of migraines.

Lasmiditan is a selective 5-HT1F agonist that lacks vasoconstrictor action, potentially offering better cardiovascular safety than triptans.

Lasmiditan works by inhibiting neurotransmitter release, reducing inflammation and migraine pain by decreasing extravasation in dural vessels.

Serotonin syndrome is a potentially life-threatening condition characterized by hyperthermia, hyperreflexia, and other neurological and autonomic symptoms.

Certain medications, such as SSRIs, MAOIs, and triptans, can trigger serotonin syndrome.

Serotonin syndrome is a potentially life-threatening condition that requires prompt medical attention.

Serotonin syndrome is a serious drug interaction that can occur when certain medications are combined.

Ergot alkaloids are a group of compounds produced by a fungus that infects grains, particularly rye. They have a long history of use, dating back thousands of years. They are known for their diverse pharmacological effects and are used to treat various conditions.

Ergotamine is the major alkaloid found in ergot. It has vasoconstrictive properties and is typically used for acute migraine treatment.

Ergonovine is an ergot alkaloid approved for treating postpartum hemorrhage, a condition characterized by excessive bleeding after childbirth.

Bromocriptine is an ergot alkaloid approved for treating hyperprolactinemia, a condition where the body produces too much prolactin, a hormone involved in lactation.

Lysergic acid is the common nucleus of ergot alkaloids. It forms the basis for the synthesis of lysergic acid diethylamide (LSD), a well-known psychedelic drug.

Ergotamine and dihydroergotamine (DHE) are ergot alkaloids that work by interacting with various receptors, including serotonin, alpha-adrenergic, and dopamine receptors. This interaction leads to vasoconstriction and inhibition of neurotransmitter release, which helps relieve migraines.

Ergot alkaloids can cause gastrointestinal side effects, including nausea, vomiting, and diarrhea. These effects are primarily due to their interaction with serotonin receptors in the gut and stimulation of the vomiting center in the brain.

Ergot alkaloids can also lead to muscle weakness, pain, and numbness in the extremities. This is attributed to their vasoconstrictive properties, which can restrict blood flow to the limbs.

Ergot alkaloids are contraindicated in pregnancy due to their teratogenic potential, meaning they can cause birth defects. They are also contraindicated in patients with uncontrolled hypertension, ischemic heart disease, and other conditions where vasoconstriction is undesirable.

Triptans are serotonin agonists that work by activating presynaptic serotonin 1B and 1D receptors, inhibiting the release of CGRP and relieving migraines. Triptans are a more recent and generally safer class of migraine medications compared to ergot alkaloids.

Small molecule drugs or antibodies that bind to CGRP or its receptor, preventing CGRP from activating the receptor and ultimately reducing migraine frequency and severity.

A class of CGRP blockers which are not antibodies. They are small molecules that can be taken orally.

A type of CGRP blocker that is a monoclonal antibody specifically targeting the CGRP molecule.

A monoclonal antibody that specifically binds to the CGRP receptor, blocking its function.

A type of migraine medication that inhibits the release of CGRP by blocking presynaptic 5-HT1B and 5-HT1D receptors.

Beta-blockers such as propranolol and timolol, anticonvulsants like topiramate and divalproex, and botox are commonly used for migraine prophylaxis.

Drugs specifically designed to reduce nausea and vomiting, a common symptom of migraine.

A dopamine receptor blocker commonly used for migraine relief.

A dopamine receptor blocker that is also commonly used to reduce nausea and vomiting.

A combination of metoclopramide and aspirin, often used for migraine relief during attacks.