Anti-Serotonin Drugs
Cyproheptadine (Periactin, Perhetine)
This drug blocks the receptors for the neurochemical serotonin in the brain and prevents dilatation of the blood vessels which cause a headache - most important factors in preventing migraine. It also has antihistamine and anti-acetylcholine effects. Its efficacy is low. This drug is often misused in children for increasing their weight. Treatment with cyproheptadine is begun with 2 to 4 mg tablet 2 to 3 times daily.
Adverse Effects and Precautions: The main adverse effects are drowsiness, dry mouth and appetite stimulation. Restrict the food intake to minimize weight gain.
Methysergide
It has been found effective in preventing attacks of migraine but it is not used or recommended nowadays because of the high incidence of serious adverse effects due to prolonged use. It is ineffective in relieving an acute attack. There are safer substitutes available now.
Adverse Effects: This causes adverse effects in 10 to 15 per cent of cases. The most serious of these is growth of fibrous tissues in the uterus, lungs, heart, blood vessels, and other organs. It causes dizziness, vertigo, mental confusion, restlessness, insomnia, and mild psychic and visual disturbances.
Amitriptyline
This is a mood-elevating drug used in the treatment of mental depression. It inhibits the uptake of serotonin in the brain and is moderately effective in preventing attacks of migraine. For prevention of attacks of migraine its dose is less than that used in mental depression. It has a sedative effect and is given in a dose of 50 to 100 mg at bedtime.
Adverse Effects: Adverse effects are mild if small doses used in migraine. It has an antiacetylcholine effect, causing dryness of the mouth and blurring in vision. The sedation caused by it is not troublesome if it is taken at bedtime.
Precautions
Take the drug at bedtime as it produces sedation.
Avoid its use if you are taking sedatives, tranquillizers, guanethidine of thyroid preparations.
Calcium Antagonists
Flunarizine (Nomigrain, Flunaril 5 mg tab/cap)
Regular intake of calcium antagonists prevents attacks of migraine. Recent studies have confirmed this finding. Of these drugs flunarizine is the most effective. Flunarizine is commonly used for prevention of migraine and is found to be as effective as propranolol. It has selective action on brain blood vessels. It is to be given once daily in a 10 to 20 mg dose at bedtime for the first 15 days, and then the dose can be reduced to 10 mg gradually.
Adverse Effects: The use of this drug may cause sedation, constipation, dry mouth, weight gain, flushing and fall in blood pressure.
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