Migraine is recurrent, severe headache without or with

• Aura (20%) (reversible focal neurological symptoms that usually develop gradually over 5 - 20 min before the onset of the headache and last for less than 60 min)

• Followed by severe throbbing headache, mostly on one side of head

Involves, among other things, involvement of trigeminal nerve distribution to intracranial arteries, with release of powerful vasodilators (CGRP) that cause vasodilation and edema, thus activating pain nerve endings

Treatment of migraine

Analgesia: Paracetamol, NSAID’s(Aspirin) - ( This works for pain by blocking the enzyme cyclooxygenase which prevents the formation of prostaglandins )

 Anti-emetics: Metoclopramide(The antiemetic action of metoclopramide is due to its antagonist activity at D₂ receptors in the chemoreceptor trigger zone in the central nervous system — this action prevents nausea and vomiting triggered by most stimuli

 Domperidone(The DA2-receptor antagonist domperidone antagonizes the inhibitory effect of dopamine, resulting in stimulation of gastric muscle contraction

 Cyclizine ( Cyclizine is a histamine H₁ receptor antagonist of the piperazine class which is characterised by a low incidence of drowsiness. It possesses anticholinergic and antiemetic properties.

Ergotamine (Vasoconstriction is produced by an agonist activity and this effect varies with different vascular beds.)

5-HT1D agonist: Sumatriptan, Zolmitriptan, Eletriptan, Naratriptan, Rizatriptan

Sedative drugs: Diazepam