Neurology case no.1 Acute Migraine attack

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Neurology case no.1 Acute Migraine attack

মাইগ্রেন_হেডেক_কেস_ডিসকাশন

How to treatment acute migraine pt?

সাবরিনা ২৭ বছর বয়স, আপনার কাছে আসলো তীব্র মাথা ব্যাথা ও বমি নিয়ে, হিস্ট্রি নিয়ে জানতে পারলেন, তার সমস্যা হচ্ছে প্রচন্ড মাথা ব্যাথা, মাথার বাম পাশে, আর রোদে গেলে ব্যাথা আরো বেড়ে যায়, ব্যাথার সময় বমি বমি ভাব হয়, চোখে ঝাপসা দেখে,

উচ্চ মাত্রার শব্দ তার মাথা ব্যাথাকে ট্রিগার করে,

এইটার ডায়াগনোসিস কি?

Tar age janbo magraine er Defination ta ki

What is Acute Migraine?

Anser is:-

A migraine is a severe Headach that causes throbbing, pulsing head pain on one side of your head. The headache phase of a migraine usually lasts at least four hours, but it can also last for days. This headache gets worse with:

Physical activity.
Bright lights.
Loud noises.
Strong odors.

Etc.

What are the types of migraines?

There are several types of migraines. The most common migraine categories are:

Migraine with aura (classic migraine).
Migraine without aura (common migraine).

An Aura is a phase of the migraine before head pain begins.

Other types of migraines include:

Migraines in Children (Abdominal pain).

Chronic Migraine

Hemiplegic Migraine

Menstrual Migraine

Migraine without headache (silent migraine).
Retinal migraine Ocular Migraine
Status Migrainosus.
Migraine symptoms:-
Prodrome: The first phase begins up to 24 hours before you experience a headache.
Aura: An aura is a group of sensory, motor and/or speech symptoms that act as a warning sign of a migraine headache. The aura phase can last as long as 60 minutes or as little as five. You might experience both the aura and the headache at the same time.
Headache: A migraine headache lasts between four hours to 72 hours.
Postdrome: The postdrome stage usually lasts for a few hours up to 48 hours. Symptoms feel similar to an alcohol induced hangover.

Prodrome symptoms

Mood changes.
Difficulty concentrating.
Trouble sleeping.

Fatigue
Nausea
Increased hunger and thirst.
Frequent urination.

Aura symptoms

Muscle weakness.
Vision changes.
Ringing in your ears(Tinnitus)
Sensitivity to touch (feeling like someone is touching you).
Numbness and tingling.
Difficulty speaking or concentrating.

Headache attack symptoms

Head pain gradually gets more intense. It can affect one side of your head or both. It can occur with other symptoms like:

Nausea and vomiting.
Light, sound and odor sensitivity.

Postdrome symptoms

Fatigue.
Stiff neck.
Sensitivity to light and sound.
Difficulty concentrating.
Nausea.
Dizziness.

How is a migraine diagnosed?

Neurological Exam ,Physical exam,CT,MRI etc.

Dx – Acute Migraine Attack.

এখন Migraine এর Acute Management কি দিবেন?

Acute Mx হিসাবে যা দিবেন-

Updated Mx of acute migraine—–

Combination of Triptan + NSAID.

Tablet1:-Rizamig 5mg (AS A Rizatriptan Benzoate AS A 5-HT Agonists)

Indications:-

Rizamig is indicated for the acute treatment of migraine with or without aura in adults and in pediatric patients 6 to 17 years old.

Or combination of Triptan +Paracetamol.

OR Tablet1:-Zolmit 2.5 mg (AS A Zolmitriptan AS A 5-HT Agonists)Updated management

Indications:-

Zolmitriptan is indicated for the acute treatment of migraines with or without aura in adults.

OR Tablet1:-Nomigran 50 mg (AS A Sumatriptan AS a 5-HT Agonists)

Indications:-

Nomigran is a serotonin (5-HT1B/1D) receptor agonist (triptan) indicated for acute treatment of migraine with or without aura in adults.

Limitations of Use:

Use only if a clear diagnosis of migraine headache has been established.
Not indicated for the prophylactic therapy of migraine attacks.
Not indicated for the treatment of cluster headache.
OR Tablet1:-Almitan 6.25 mg (AS A Almotriptan AS A 5-HT Agonists)..

Indications:-

Almotriptan is prescribed to treat the acute headache phase of migraine attacks with or without aura. Almotriptan is the only oral triptan approved in the USA for the treatment of migraine in adolescent from 12 to 17 years of age.

So update Rx-

Tab: Zlomit 2.5 mg

1 tab stat.

Tab – Naproxen 500 mg stat( AS A Naproxen sodium Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs))

Indications

Naproxen is indicated for the relief of sign and symptoms of-

rheumatoid arthritis
osteoarthritis
ankylosing spondylitis
juvenile arthritis
tendonitis
bursitis
acute gout

It is also indicated for the management of primary dysmenorrhea & pain.

Side Effects of Naproxen:-

Most frequently reported side effects include following:

Gastrointestinal: Heartburn, abdominal pain, nausea, diarrhea, dyspepsia.
Central Nervous System: Headache, vertigo, drowsiness.
Dermatological: Pruritus (itching), purpura.
Cardiovascular: Edema, palpitation.
Others: Visual disturbances, hearing disturbances.

+ Sargel 20 mg stat

+Tablet: Omidon 10 mg stat

(Omidon AS A Domperidone Maleate AS a Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs).

Indications of Domperidone:-

Dyspeptic symptom complex, often associated with delayed gastric emptying, gastroesophageal reflux and esophagitis:

Epigastric sense of fullness, feeling of abdominal distension, upper abdominal pain
Eructation, flatulence, early satiety
Nausea and vomiting
Heartburn with or without regurgitations of gastric contents in the mouth
Non-ulcer dyspepsia

Acute nausea and vomiting of the functional, organic, infectious, dietetic origin or induced by radiotherapy or drug therapy or induced in migraine.

Parkinson’s disease: In dopamine-agonist induced nausea and vomiting.

Radiological studies: Speeding barium transit in follow-through radiological studies.

Side Effects Of domperidone:-

Side-effects are rare; exceptionally some transient intestinal cramps have been reported. Extrapyramidal phenomena are rare in young children and exceptional in adults: they reverse spontaneously and completely as soon as the treatment is stopped. As the pituitary gland is located outside the blood-brain barrier, domperidone may induce an increase in the plasma prolactin level. In rare case this hyperprolactinaemia may give rise to neuroendocrinological phenomena such as galactorrhoea and gynaecomastia. When the blood-brain barrier is immature (as in infants) or impaired, the possible occurrence of neurological side-effects cannot be totally excluded. Rare allergic reactions, such as rash and urticaria, have also been reported.

Naproxen এর জায়গায় Napa 1000 mg দিলেও হবে….

Note it forever ——– (IHD +Cerebrovascular disorder থাকলে Triptan দেওয়া যাবেনা)

Acute migraine এ এই treatment টা ৩ দিন চলবে——– দিনে ২-৩ বার করে………৷

Triptan একটা দিলে না কমলে ২ ঘন্টা পরে আবার, না কমলে ২ ঘন্টা পরে আবার দিবে——-

[[Triptan হিসাবে যা ব্যবহার করা যেতে পারে.

zolmitriptan 2.5 mg (Maximum 10 mg daily)

Sumatriptan (Maximum 200 mg Daily, initially 50-100 mg)

Rizatriptan (5-10 mg initially, maximum 20 mg Daily)

All Triptan can given BD /TDS dose]]]]

Note : Migraine একবার হলে বার বার হয়, সেইজন্য prophylaxis দিতে হয়, এখন

সাবরিনা কে Prophylaxis দিবেন কি দিবেন না?

Prophylaxis 5 ধরণের ঔষধ পাওয়া যায়…

BCDEH..

B=Beta Blocker = propranolol (Tablet:Indever 10 mg AS A Propranolol hydrochloride as a Beta-adrenoceptor blocking drugs, Beta-blockers)

Indications of Indever:-

Indever is indicated in:

Essential hypertension
Angina pectoris
Cardiac arrhythmia
Thyrotoxicosis
Anxiety
Prophylaxis of migraine, etc.

C=Calcium channel blcker= Flunarizine, verapamil (tablet:-Flurizin 10 mg AS A Flunarizine AS A Miscellaneous prophylactic migraine preparations).

Indications of Flurizin:-

Flurizin is indicated for

Prophylaxis of classic (with aura) or common (without aura) migraine
Symptomatic treatment of vestibular vertigo (due to a diagnosed functional disorder of the vestibular system).
Peripheral Vascular Disease (PVD)
Motion sickness
Refractory epilepsy resistant to conventional antiepileptic therapy.

D =Antidepressant =Amitriptyline (Tablet:- Tryptin 25mg AS A Amitriptyline Hydrochloride AS A Tricyclic Anti-depressant ).

Indications OF Tryptin:-

Tryptin is indicated in-

Depressive Illness: particularly where sedation is required.
Nocturnal Enuresis in children.
Prophylaxis of Migraine.
Tension Headache.
Chronic Pain.

E= anti- Epileptics =Topiramate (Tablet:Epimed 25 mg AS A Topiramate Adjunct anti-epileptic drugs).

Indications of Epimed:-

Epilepsy: Epimet is indicated as monotherapy in adults and children aged 6 years and above with newly diagnosed epilepsy who have generalised tonic-clonic seizures or partial seizures with or without secondarily generalised seizures. Epimet is indicated as adjunctive therapy for adults and children over 2 years of age who are inadequately controlled on conventional first line antiepileptic drugs for partial seizures with or without secondarily generalised seizures; seizures associated with Lennox Gastaut Syndrome and primary generalised tonic-clonic seizures.
Migraine: Epimet is indicated in adults for the prophylaxis of migraine headache. Prophylactic treatment of migraine may be considered in situations such as: adults experiencing three or more migraine attacks per month; frequent migraine attacks that significantly interfere with the patient’s daily routine. Continuing therapy should be reviewed every six months.

H= antihistamine =Pizotifen (Tablet:-Migranil 0.5mg AS A Pizotife AS A Anti-histamine Preparations, Other drugs for migraine).

Indications of Migranil:-

Migranil is indicated as prophylactic treatment of vascular headache of migraine type such as classical migraine, common migraine and cluster headache. It is not effective in relieving migraine attacks once in progress.

এই ৫ প্রকার থেকে কখন কাকে কোন টা দিবেন?

Migraine e monotherapy দিবেন, নাকি duel therapy দিবেন?

Monotherapy and duel therapy এর ইন্ডিকেশন কি?

Propranolol দিয়ে চিকিৎসা শুরু করবেন নাকি Amitriptyline?

Raiyyan Tahsan

Articale made by Raiyyan Tahsan date:27-10-2024 at 10.44pm sunday.

Raiyyan Tahsan

Raiyyan Tahsan