In this article, we will discuss the Use of Ergot derivatives, Triptans and Neuroleptics in the Management of Acute Headache. So, let’s get started.
Ergot derivatives, Triptans and Neuroleptics
Ergot derivatives and triptans: The ergot derivatives (ergotamine and parenteral dihydroergotamine)or cafergot (combination of ergotamine and caffeine) are useful in symptomatic relief of moderate
to severe migraine, cluster headache
and intractable chronic daily headache, dihydroergotamine (DHE) can be given I.M. or 1.V. (0.5 to 1 mg) alone or in combination with promethazine and dexamethasone (1 mg DHE plus 50 mg promethazine and 4 mg dexamethasone I.M.) to abort most migraine headaches.
All ergotamine preparations produce
nausea, vomiting, muscle cramps,
paraesthesias and precipitate angina.
Anticonvulsants such as topiramate,
valproate are also useful in migraine.
Triptans (sumatriptan, zolmitriptan,
naratriptan, rizatriptan) are useful in
the treatment of migraine and cluster
headache. Sumatriptan (25-50 mg
orally or 6 mg subcutaneously) or
zolmitryptain 5 mg orally or nasal spray gives fastest relief in acute attack of migraine.
Triptans are contraindicated in pregnancy, hemiplegic or basilar migraine, in patients with risk factors for stroke and coronary and peripheral vascular disease.
Neuroleptics (e.g. metoclopramide and domeperidone) are useful to control the associated nausea and vomiting associated with migraine and cluster headache.