January 27, 2023


Are more than three attacks every month then it is better to start prophylaxis so in prophylaxis whatever combination of drugs you use success rate is almost up to 50 percent and fda drug approved drugs are only few like propranolol simular sodium health product interferometer i am going to discuss each medicines in future slides so when do you call the treatment

Is successful if patients frequency of attacks radius less than 50 percent within three months of period time the treatment is successful and minimum how many days trial should be there eight weeks trial with one drug before changing to any other drug means if you started one medicine like for example problem load don’t change if the frequency of addiction are

Going within three weeks eight weeks like minimum eight weeks of trial is needed and every time prophylaxis treatment it should go for six months and uh in this six months also particularly for the few medicines last two weeks you should staple slowly the dosage then stop now and these migraine prophylaxis treatments generally usually only one tablet or two

Times daily daily treatment you will take and to start seeing the effect it will take minimum two weeks or two to twelve weeks to start seeing any effect and apart from fda approved drugs there are some other drugs which are seen clinically effective some study but not yet approved in the fda and that most commonly used is this flu narrative ametriptyline no

Tripling phenylsensical and now new drug has come that is a monoclonal antibody to cgrp receptor that is a adenoma and there are some other antibodies to some specific proteins also and these are just only once in a month injections these are used particularly if there are a lot of side effects with other drugs and the patient can’t tolerate this you can use

This the safety profile is well and it is almost about to come to the market so first let us discuss about the most commonly prescribed particularly in indian subcontinent the medicine for prophylaxis that is fluna resin therapy also calcium channel blocker but funeral reason is most commonly and commercially it is brand name is civilian before starting any

Medicines even if you are not doctor also definitely you should know the side effects of the medicines or the contraindications of the medications and side effects means the effects which can be tolerated but still patient can take contraindication means never give that if you do harm is more than benefit the counter-indicated fiona reason is contraindicated

In depression parkinson’s disease or extrapyramidal side effects in ocular porphyria gi abstraction or urinary tract obstruction and this is as i said particularly in indian subcontinent this is first choice of prophylaxis and this is also first choice in women of child bearing age because it is every a category c so many other drugs one important thing i want

To tell that most almost all type of prophylaxis drugs for the migraine which is taken you should always remember that one of the most common side effect is weight again most of these drugs they cause weight gain in those individuals see most commonly we see migraine in child-bearing ladies if you give any other medicines which have a side effect to the babies

That are not safe that is also another reason even clinically also most commonly used this cybilium category c it is fda category c so this is another good option so what it does phenology it acts by cerebral selective calcium channel blocker and how it affects in the migraine so it reduces intracellular calcium overload due to the brain hypoxia again as i said

This sedation constipation and weight gain is the side effect so you should start one small tablet 10 mg daily in the night particularly in the patients less than 65 years if the patient is more than 65 years of 5 mg you can give and initially you try to prescribe for two months and you will see the difference if there is no difference you should stop if there

Is no refined even until two months and generally the maintenance is given like you know five days a week saturday sunday of no tablet like that and uh the course is for six months after that you stop it again if the patient is getting again again migraine attack then again you can start for another six months after that the one the first one common tablet used

For prophylaxis is propanol and propanol is in a patient good for having migraine plus they’re also having either medicine problems with the tremors anxiety panic attack and we should also see the bp bp also should be normal if the variations need it is low you cannot use this so again uh this the tablet you can take with the capsule it can take without food

And tablet on them system up only so this beta believers are not recommended in patients with more than 60 years of age and smokers among beta blockers three have been shown in preventing migraines propanol oil metaprolon and t-mobile propranolol is most commonly prescribed it is first-line agent and again if they get a selection in origin but this has got lot

Of other side effects like you cannot take when the patient is having asthma attack or cardiac problems or other things okay so in this part initially 40 mg two times daily will start and you can go up to 80 to 160 mg and the contraindication is as i said mainly here the bronchial asthma bradycardia cardiogenic shock low bp i said if we should see always before

Starting this medicine if beef is normal or higher side then only you can start this and the sphere chromosome of heart failure is also seen one more common tablet which is used to fda first line according to the american this thing and the standard prescription for prophylaxis even in the gulf countries that is topiramate but valkyrie can dial products

Sodium also has shown but procurement is standard but this is category d it means never give any woman with a child bearing age because it can have a lot of side effects for the infants and it is recommended as a first line prophylactic agent for a chronic migraine and initially she stood 25 mg once in a night for one week then slowly increased to weekly

Interval and the usual dose is usually 50 to 100 milligram per day two divided doses so they are indicated particularly in patients affected to other drugs or when proper novel oil is contraindicated and the contraindications for these medicines particularly dystrophy if patient has taken alcohol in less than six hours of age our patient is generally alcoholic

Don’t give this patient with metabolic acidosis on metformin and even of course pregnancy as i told it is category d there is one more tablet is called dival project sodium also sodium oxide in this category here one of the side effect is aloe vera calling of hair weight gain is seen in almost all increased bleeding tendency also the contraindication for these

Steroids is pre-existing liver diseases for failure urea cycle disorders so for prophylaxis initially 250 mgpd will start and then slowly you can increase to 500 mdbd and anorexia vomiting loose motions and heart burns are generally general common side effects but on severe side effect is fulminant quadratus it caused particularly in the children below three

Years where suddenly patients will have a sudden liver failure one more class of the drugs antidepressants most commonly used is this american marketed in trade name as a triptomer so many other brands are there so if patient is having migraine attacks plus if they are also having either depression or insomnia then you use this amicryptalin so this is also among

The first line medicine where you used for chronic magram prophylaxis and prophylaxis of migraine in these things initially 10 mb even though patient may need 1mg milligram per kg body weight but generally these people they call that 10 mg only a lot of cases it has seen that it has reduced migraine attack as well as copped up with the insomnia problem also

The contraindication mainly here is recent my arrhythmia coronary artery insufficiency and it should not be given less than six years also as i told one more the new drug head start has come this is calcitonin gene related peptide antagonist and the most common here is the adenoma you will get this as a subcontinent’s injection uh this is a human monotonical

Antibody that acts by binding to and inhibiting cgrp receptor or ligand so this supportiveness is same like insulin it is given even you will get sometimes needle free device also and this is just only once in a month so initially only 70 mg is given but you can adjust almost up to 140 so particularly this is indicated if all other drives have either side effect

Or dots are not useful then you use it so one more is visualization this is not used generally nowadays it’s almost so i’m not discussing much in that but even the cluster attack even in the migraine also it is used so there is one more next is bottling injection this is off label medicine not fda approved but if you give bottleneum injections particularly in

The sides of the head where the patient is frequently getting in that side migraine attacks it is given approximately every two weeks multiple injections around the head and neck generally it is seen that it is reducing the severity of migraine attack and some like coins and q 10 tablets uh capsules also you will get commercially these are generally no evidence

But because they are saved they have been prescribed frequently and i want to talk here about some

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