How Do I Use Nortriptyline for Migraines?

The medical treatment of migraine consists of two parts: symptomatic treatment and preventive treatment. The goal is to stop the course or relieve headaches, while preventive treatment is to reduce the frequency and severity of expected headache attacks.

Medication for migraine

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The medical treatment of migraine consists of two parts: symptomatic treatment and preventive treatment. The goal is to stop the course or relieve headaches, while preventive treatment is to reduce expectations

Migraine is a paroxysmal headache disorder characterized by various neurological, gastrointestinal, and autonomic changes. The pharmacological treatment of this disease consists of two parts: symptomatic treatment and preventive treatment. The purpose of symptomatic treatment is to halt the course of the disease or relieve headaches, while preventive treatment is to reduce the frequency and severity of expected headache attacks.

The use of analgesics is the first step in the treatment of headache symptoms, and many patients can be effective with analgesics alone or with caffeine. Butabitur is a short-acting barbiturate, often used in combination with sedatives and caffeine. The combination of acetaminophen, isometine, and chloralbiline can also safely and effectively treat headaches. In the acute treatment of headache, a combination of analgesics, antiemetics and anxiolytics has been successfully reported. If the combination of non-opiates and analgesics fails, one of the following joint programs should be used: aspirin or acetaminophen, caffeine, butabitur, codeine; acetaminophen, Coteine; acetaminophen, butabital, codeine. Nerve blocking agents such as chlorpromazine and prochlorperazine, especially when administered intravenously or intramuscularly, can not only effectively suppress nausea and vomiting, but also relieve migraines.
More powerful narcotic analgesics such as dextropropoxyphene, pethidine, morphine and oxycodone can be used alone or in combination with simple analgesics, but because of the risk of addiction and headache rebound Only suitable for patients with frequent headache attacks. Nasal inhalation of butorphanol tartrate, given 1 mg every 1 h, is the best treatment for migraine acute palpitations. The possibility of using opioids is necessary for certain patients with regular manifestations, such as women with refractory menstrual migraine. These drugs also help treat patients whose pain cannot be relieved with analgesics alone and who are contraindicated or intolerant to ergot and sumatriptan. Pregnant women should be cautious with codeine or pethidine. Anesthetics can also be used as first aid or for patients awakened by midnight headaches.
NSAIDs block the prostaglandin synthesis by inhibiting cyclooxygenase, which is the mechanism of this product's anti-inflammatory, analgesic and antipyretic effects. When NSAIDs are used to relieve headaches, each drug should be limited to the lowest amount. Indomethacin 50mg rectal suppository is most suitable for patients with severe nausea and vomiting.
Ergot and DHE For patients with moderate or severe migraine who cannot relieve headache or have obvious adverse reactions with simple analgesics, ergotamine and DHE can be used. DHE is an ergotamine derivative. Although arterial vasoconstriction is weaker than ergotamine, it has a strong venous constriction effect. The bioavailability of ergotamine is completely dependent on the route of administration, oral absorption is variable, and rectal absorption is relatively stable. In patients who cannot tolerate ergotamine due to nausea, metopramine, prochlorperazine, promethazine, or a barbitur and belladonna alkaloid mixture can be used for preventive treatment. Oral metoclopramide can also increase the oral absorption of ergotamine. DHE in 1mg / ml ampoules can be used for IM, SC or IV injections. Bioavailability and blood concentration are the highest during IV injections and the most unstable when SC injections. The dose should be limited to 1 mg IM or IV, with a maximum of 3 mg / d and controlled at 18 ampoules per month. Compared with ergotamine, DHE is less likely to cause headache rebound. Contraindications to cultured ceramide or DHE include pregnancy, hypertension, sepsis, renal or liver failure, and coronary, vein, and peripheral vascular disease. DHE side effects include dizziness, paresthesia, abdominal cramps and chest tightness, and arterial and coronary-specific spasm reactions are rare.
Sumatriptan is a newer acute migraine treatment and is a selective 5-HT1 receptor agonist. SC injection of this product within 10 minutes of pain relief, can eliminate nausea, photoelectric horror and sound horror, can also relieve and prevent migraine attacks during surgery, menstrual-related migraine and early morning migraine. Although the efficacy of oral sumatriptan is comparable to that of SC injections, the onset of action is longer. Ischemic heart disease, Prinzmetal's angina pectoris, and vertebral base migraine are contraindicated for sumatriptan use. Side effects of this product include pain at the injection site, tingling sensation, skin flushing, burning, and heat. Dizziness, depression, neck pain, and irritability also occur. These adverse reactions usually disappear within 45 minutes. Non-cardiogenic chest tightness occurs in about 4% of patients. Therefore, the first dose of sumatriptan should be used in patients at risk of angina pectoris and should be closely monitored.

Currently, drugs used for the treatment of preventive migraine include -adrenergic blockers, antidepressants, calcium channel antagonists, 5-HT antagonists and anticonvulsants. When taking the drug, it should be started from a low dose and slowly increased until the efficacy or side effects appear. Full treatment takes 2-6 months.
Beta-blockers are the most widely used drugs in the prevention of migraine, with an effective rate of 60-80%, which reduces the frequency of headaches by more than 50%. Many controlled studies have shown that propranolol, metoprolol, timolol, naldolol, and atenolol reduce the frequency of attacks in patients without or with migraine. All beta-blockers have behavioral side effects such as drowsiness, fatigue, lethargy, sleep disorders, depression, memory disorders, and hallucinations. Common side effects include complaints of the gastrointestinal tract and reduced exercise tolerance. Rare side effects include orthostatic hypotension, severe bradycardia, impotence, and worsening visceral myopathy. Beta-blockers are particularly useful in patients with angina pectoris and hypertension.
Antidepressants Tricyclic antidepressants and atypical antidepressants such as selective 5-HT reuptake inhibitors and trazodone can increase high-angle norepinephrine or 5- Availability of HT. Monoamine oxidase inhibitors prevent catecholamine degradation. TCA commonly used for the prevention and treatment of migraine and tension headache are amitriptyline, nortriptyline, doxepin and protiline. The new atypical non-TCA drug fluoxetine is a powerful and specific 5-HT uptake inhibitor with less antihistamine and antimuscarinic effects. According to Anecdotal's research report, this product seems to be effective in the prevention of extended headache. The side effects of TCA are more common and most are related to its antimuscarinic effects, such as dry mouth and sedation. TCA can also cause increased appetite, occasional cardiotoxicity and orthostatic hypotension, and these drugs are especially suitable for patients with depression and anxiety disorders at the same time.
Calcium channel blockers Calcium channel blockers for cardiovascular disease are a group of chemically heterogeneous drugs. Flunarizine is effective, but its use in the United States is limited due to adverse reactions and inconvenience. Verapamil is effective, and nifedipine and diltiazem have not been extensively studied. The effectiveness of nimodipine is unclear. The side effects of various calcium channel blockers vary widely, including dizziness and headache, depression, vasomotor symptoms, tremor, complaints of the gastrointestinal tract, peripheral edema, orthostatic hypotension, and tachycardia. Patients often complain of aggravating headaches initially, but they resolve after a few weeks of treatment. Calcium channel blockers are particularly useful in patients with concurrent hypertension and those with contraindications to beta-blockers such as asthma and Raynaud's disease. In addition, it also has a good effect on patients with a long threatening period or vertebral base migraine.
The 5-HT antagonist mesaget is a semi-synthetic ergosterol 5-HT2 receptor antagonist. Long-term use can prevent the occurrence of neurogenic inflammation. The effectiveness of this product in preventing migraine is above 60%, especially for patients with migraine with threat. The side effects of this product are transient myalgia, broken lines, abdominal discomfort, nausea, weight gain and hallucinations. Horrifying hallucinations after the first treatment are not uncommon. Serious complications of mesaget such as retroperitoneal, pulmonary or intracardiac fibrosis are rare. For this reason, there should be a 4-week no-drug interval after every 6 months of continuous treatment. Cyproheptadine has antagonistic effects on 5-HT2, histamine H1, and muscarinic cholinergic receptors, and is widely used in the prevention and treatment of migraine in children. Curran and Lance found that this product is more effective than placebo in adults, but less than Meshegit. Phenothidine is a 5-HT2 receptor antagonist with a structure similar to cyproheptadine. Controlled and non-controlled studies conducted in Europe show that the effective rate of this product is 40-79%, the commonly used amount is 3mg, taken before bedtime. Side effects are drowsiness and weight gain.
Anticonvulsants such as migraine have been used for a long time, especially in children. The most commonly used anticonvulsant is valproic acid. At high concentrations, this product can increase the GABA level of the horn, and can also strengthen the GABA response after the horn. Valproic acid terminates the ignition of dorsal suture 5-HT neurons, which is the mechanism for controlling headache. Studies have reported GABA metabolism disorders and changes in GABA and glutamate blood levels during migraine. At least three double-blind trials confirm the efficacy of valproic acid in the prevention of migraine, such as a double-blind randomized cross-over study of 29 patients with or without threatened valproic acid or placebo for 8 weeks Tests show that the effective rate of valproic acid is 86.2%
Several open studies have also confirmed the therapeutic effect of dlalproex on migraine and transformative migraine, and its preventive effect is related to blood concentration. Divalproex side effects include sedation, hair loss, tremor, and changes in cognitive manipulation. Transient nausea, vomiting, and indigestion can also occur. Liver toxicity is the most serious side effect, so function monitoring is required. Irreversible liver damage is rare in adults, but in migraine patients with severe epilepsy, anxiety disorders, or manic-depressive disorders. Due to its good safety, it has been gradually recommended for the treatment of depression, Raynaud's disease, asthma, and diabetes, which is contraindicated to -blockers.