ANTI-MIGRAINE

MACP 2113

Disediakan oleh:
Pn. Nirmala Devi Tailan
Pengajar U41
Kolej Pembantu Perubatan, Ulu Kinta
 OBJEKT
IF
1. Memberi definisi ubatan anti-
migraine.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.
 Migrain
e
• Sakit kepala berulang-ulang
serta berdenyut.
• Melibatkan sebelah kepala.
• Diikuti prostasi dan
(kepenatan yang keterlaluan)

muntah-muntah.
• Arteri kranial pada bahagian
kepala akan mengembang
(dilate).
 Anti-Migraine

• Ubat yang digunakan untuk

merawat migraine.
 Contoh ubat
• Paracetamol (Panadol)
• Ergotamine Tartrate
(Ergostat)
• Methysergide (Sansert)
• Propranolol (Inderal)
1. Paracetamol
(Panadol)
Category: C
 Tindakan

• The exact mechanism by

which it prevents migraine
headaches is unknown.
 Dose
• Dose Adult:
– 500-1000mg tid PO
– Tidak melebihi 4g/day
• Dose Peadiatric:
– <500mg/day
 Kesan Sampingan
• Hepatotoxicity (keracunan hati)
• Jaundice
• Acute kidney failure
• Hemolytic Anemia
• Pancytopenia(reduction of RBC)
• Headache
• Rashes
 Contraindication
• Allergy to paracetamol

Cautious
• Impaired hepatic function
• Pregnancy
• Lactation
 Drug Interaction
• Barbiturates,
Carbamazepines, rifampin,
sulfinpyrazone
– Increased risk of hepatotoxicity
– Decreased therapeutic effects
• Anthicholinergics
– Decreased effectiveness
 2. Ergotamine
Tartrate (Ergostat
2mg)
Category: B
 Tindakan

• Mengecutkan salur darah

kranial
• Mengurangkan denyutan
arteri kranial.
 Dose
• 1 tab (2mg) sublingual (after
1st migraine attack)
• May repeat 1 or 2 times if
necessary
• Do not exceed 3 tabs/d or
10mg/wk
 Kesan Sampingan
• Nausea (mual)
• Vomiting (muntah) Ergotism
• Diarrhea
• Thirsty (dahaga)
• Drug dependency (ketagihan)
• Numbness (kebas)
• Bradycardia
 Take Note
• Long term use:
– Vasoconstriction of blood
vessels in the toes (jari kaki),
fingers, hands & feets causes
gangrene (kehilangan bahagian
terlibat).
– Constriction of vessels in the
retina of eye may cause
blindness (hilang penglihatan).
 Contraindication

• Allergy to ergot preparation

• Peripheral vascular disease
• Severe hypertension
• Pregnancy (hamil)
• Lactation (menyusu)
 Drug Interaction

• Beta Blockers
– Possible peripheral gangrene
• Macrolide antibiotics,
Protease inhibitor, Anti-
fungal (azole)
– Risk of serious toxic effects
3. Methysergide (Sansert)

Category: B
 Tindakan

• Menghalang kesan serotonin

yang terlibat dalam
mekanisma ‘vascular
headache’.
 Dose

• 2mg tid PO
• May be used for 6 months
• Followed by drug free period
of 3 – 4 weeks
 Kesan Sampingan

• Retroperitonial fibrosis
(jangka panjang)
– Connective tissues
– Pulmonary tissues
– Aorta
– Inferior vena cava
• Nausea, vomiting, diarrhea
• Heartburn (pedih hulu hati)
• Abdominal pain
• Insomnia
• Dizziness
• Edema
 Contraindication
• Allergy to drugs
• Pheripheral vascular disease
• Severe arteriosclerosis,
• Severe hypertension
• Pulmonary disease
• Pregnancy
• Lactation
 Drug Interaction

• Ergot alkaloids, nicotine

– Increase vasoconstriction
• Narcotic analgesics
– Reverse analgesic activity
4. Propranolol (Inderal)

Category: B
 Tindakan
• Bertindak ke atas CNS untuk
mengurangkan ‘sympathetic
outflow’ dan vosoconstrictor
tone.
• The exact mechanism by
which it prevents migraine
headaches is unknown.
 Dose
• Initial:
– 40 – 80mg/day (divided dose)
PO
• Maintenance:
– 160mg/day
 Kesan Sampingan

• Orthostatic hypotension
• Drowsiness (mengantuk)
• Gastric pain
• Bradycardia
• Respiratory distress
• Chronic Heart Failure (CHF)
 Contraindication
• Allergy to beta-blockers
– Sinus bradycardia
– 2nd & 3rd degree heart block
– Bronchial asthma
– COPD
– CHF
– Pregnancy
– Lactation
 Drug Interaction
• Verapamil
– Increased effects of
propranolol
• Indomethacin, Ibuprofen,
Piroxicam, Barbiturates
– Decreased effects of
propranolol
 Soala
n
1. Beri definisi ubat Anti-
migraine?
2. Senaraikan ubat-ubat anti-
migraine serta cara
tindakannya?
3. Nyatakan kesan sampingan dan
kontraindikasi ubat anti-
migraine?