Which vascular changes can be observed before and during migraines?

Once chemicals in the brain are released they move to the meninges of the brain which leads to inflammation and swelling of the blood vessels. This causes an increase in blood flow around the brain. This is what is suspected to cause the throbbing pain that people experience during a migraine.

What is the role of serotonin in migraine headaches?

Serotonin is needed for communication between nerve cells. It can lead to the narrowing of blood vessels in the body, which will counteract the throbbing pain that is felt. If serotonin levels - or oestrogen levels in women - change, the result can be a migraine.

How is ergotamine used during a migraine attack?

Take at the first sign of a migraine. Place a tablet under your tongue and allow it to dissolve. Take 1 tablet every 30min as needed. no more than 3 tablets within 24hours.

Which side-effects are experienced with ergotamine use? Which contra‑indications exist for using ergotamine?

Side effects: Nausea, vomiting, diarrhoea, hallucinations, gangrene (due to ergotamine being a strong vasoconstrictor), tachycardia, rebound headache

Contraindications: Cardiovascular disease, hypertension, liver and kidney impairment, pregnancy, psychosis

Which other drugs can be used for an acute migraine attack?  What is the action of all of these drugs?

• Analgesics (Aspirin/paracetamol?NSAIDs) - relieves pain
• Antiemetics (Metoclopramide, Cyclizine) - Relieves nausea and vomiting
• Ergotamine - vasodilator, decreases pain
• 5-HT1D agonist (Sumatriptan / Zolmitriptan) - constricts large arteries, inhibits trigeminal nerve transmission & vasoactive peptide release.
• Sedative (Diazepam) - sedates the person so that they can sleep.

Name the drugs which can be used for migraine prophylaxis, as well as their specific side effects and precautions

• β-blockers (Propranolol)

Side effects: fatigue

Precautions:

• α2 agonist (Clonidine)
• Ca²⁺ blockers (Verapamil)
• TCA (Amitriptyline)

Side effects: dry mouth

• Anti-epileptic drugs/anti-convulsant (Valproic acid, valproate, topiramate)

Side effects: nausea

• 5-HT2 antagonist (Pizotifen, Cyproheptadine, Methylsergide)

Precautions: There is strong evidence to support the use of metoprolol, timolol, propranolol, divalproex sodium, sodium valproate and topiramate for the prevention of migraines