- Compounds based on Lysergic Acid

- Amine or amino side chain

- Non-selective pharmacological agents that interact with:

• α-adrenergic receptors
• serotonergic receptors (5-HT₁ and 5-HT₂)
• dopaminergic receptors

- Anti-migraine effects likely mediated via 5HT_1B/1D receptors.

- Excessive use: Rebound Headaches, coronary vasospasm, ergotism (toxic effects of chronic ergot use - convulsions, hallucinations, dry gangrene etc...)

Common Side Effects:

• N&V
• Tingling in extremities
• Abdominal Pain
• Muscle aches/tremors

- Agonists are highly selective for 5-HT_1B/1D receptors

- Inhibit cGRP release

- Inhibit vasodilation

• Drowsiness
• Dizziness
• Fatigue
• N&V

- 5-HT_1B/1D agonist

- Inhibitor of proinflammatory NTs

- Closes carotid anastamoses

- Single dose effective in decreasing migraine severity (80%)

- Subcutaneous: Rapidly absorbed, high bioavailability, max concentration in 10 min., faster onset than ergots

- Oral: Only 15% bioavailable, max concentration in 1.5 hours, can titrate, more effective that ergotamine/caffeine combo.

- Intranasal: do not give 2 doses w/in 2 hours of each other, relief in 15-60 minutes post-dose, minimal side effects

- Similar to sumatriptan

- Less HA recurrence

- Better bioavailability

- Prolonged duration of action

- Take tablet at onset of HA

- More rapidly absorbed than sumatriptan

- Tablet form

- Better oral availability than sumatriptan

- Use with caution in pts. with liver disease (clearance reduced which can lead to hypertension**)

- Sumatriptan/Naproxen (Takes care of the neuronal and vascular)

- 5-HT_1B/1D agonist + NSAID

- Constricts basilar artery and vasculature of dura mater

- Inhibits synthesis of inflammatory mediators (prostaglandins)

- No significant effect on adrenergic, dopaminergic, muscarinic or benzodiazepine receptors

Contraindicated w/ any form of vascular disease or hepatic impariment, don't use with ergots

- 3 or more attacks/month

- Do not respond to symptomatic R_x

- Migraines that are predicatable in occurence

- Start at low doses and titrate up

- Treat for 3-6 months and then titrate off treatment

Ergotamine

Dihydroergotamine

-class

-mechanism

• partial α-adrenergic receptor agonist
• partial 5-HT₁ receptor antagonist
• ergot alkaloid - amino acid

Bromocriptine

-class

-mechanism

• dopamine receptor agonist
• Ergot alkaloid - amino acid

Methysergide

-class

-mechanism

• 5-HT₂ receptor antagonist
• Ergot alkaloid - amine

Beta blockers

Calcium channel blockers

Tricyclic antidepressants

Anticonvulsants

Methysergide

Supplements (riboflavin, magnesium)

Ergot derivatives

Serotonin agonists

NSAID's, aspirin, acetominophen

Combination drugs (ex: excedrin migraine)

Opiates

COX inhibitors/blockers

Angiotensin II receptor blockers

Treximet = sumptriptan + Naproxen

(triptan + NSAID)