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NSAID + Anti-emetic (migraleve ®)

There are two colours of migraleve both are available OTC as well as on prescription.

Pink tablets contain: buclizine hydrochloride 6.25 mg (anti-emetic), paracetamol 500 mg, codeine phosphate 8 mg. Dose = TT if attack imminent or at onset.

Yellow tablets contain: paracetamol 500 mg, codeine phosphate 8 mg (and so are the same as basic co-codamol 8/500). Dose TT up to four hourly (max dose = 2 pink + 6 yellow per day)

Sumatriptan: Two mechanisms have been proposed to explain the primary mode of action of this drug: vasoconstriction, and trigeminal nerve terminal inhibition. Triptans appear to work by stimulation of serotonin (5-HT1B and 5-HT1D) receptors

Sumatriptan is a potent vasoconstrictor of intracranial arteries (5HT1B) It has been shown to increase blood flow velocity in large intracranial arteries in a dose-dependent fashion both during and between migraine attacks. Sumatriptan also causes rapid constriction of dural and meningeal vessels in vivo. It does not modify cerebral blood flow but does constrict arterio-venous anastamoses that may be dilated during a migraine attack.

Alternatively, sumatriptan may act directly on the trigeminal sensory nerve terminals (5HT1D) within the cranial blood vessel, inhibiting the release of sensory neuropeptides.

For patients who do not gain control with more general approaches, the triptans have proved to be a life-changing therapeutic option, although only a minority of those who could possibly benefit from them have been exposed to them. Sumatriptan is available in a subcutaneous and intranasal formulation to avoid the upper GI tract. This drug is, therefore, attractive for patients who have early vomiting as a major feature of their migraine. These formulations also have a quicker action than tablets. Sumatriptan is available in both 50mg and 100mg tablets.

Migraine Prophylaxis by A. McLeod

The beta-blockers propranolol, metoprolol, nadolol, and timolol are all effective. Propranolol is the most commonly used in an initial dose of 40 mg 2 to 3 times daily by mouth. Beta-blockers may also be given as a single daily dose of a long-acting preparation. The value of beta-blockers is limited by their contra-indications and also by their interactions (see cardiac drugs).

Pizotifen is an antihistamine and serotonin antagonist structurally related to the tricyclic antidepressants. It affords good prophylaxis but may cause weight gain. To avoid undue drowsiness treatment may be started at 500 micrograms at night and gradually increased to 3 mg; it is rarely necessary to exceed this dose.

Reversal Agents

Acetylcysteine (Parvolex) by Rachel Jones

Indications: Paracetamol overdosage

Mode of operation:

Acetylcysteine is converted to glutathione by L-cysteine. Glutathione is a powerful antioxidant, which reduces paracetamol and acts as a conjugating agent, preventing damage to other molecules or cells. It protects the liver if given within 24 hours.

Side Effects:


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