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Drugs An attack of migraine may last for several hours and varies in severity. In some, attack is mild and required simple pain relievers. In others it is severe and disabling and therefore needs to be treated with specific anti-migraine drugs. The drugs for treatment of migraine are of two types: 1) those used for relief in an acute attack; 2) those used for prevention of future attacks. Drugs Used in Acute Attack Ergotamine Tartrate (Ergophen, Vasograin) Ergotamine is the drug of choice in the treatment of an acute attack. It causes constriction of blood vessels of the head which are dilated during an attack. It is most effective if taken before the attack starts, that is, when prodromal symptoms appear. It should not be used for long- term prophylaxis (preventive treatment) because of its potential adverse effects. Dosage: The dosage of ergotamine should be individualized to determine an appropriate amount for subsequent attacks. In Western countries it is given by inhalation which has a more rapid effect than the oral route. It is generally used in a dose 2 mg at the onset of attack, followed by 1 mg every hour until the headache is relieved, or a total dosage of 6 mg has been reached. In some people who have severe nausea or vomiting due to migraine it can be given by inhalation or as rectal suppository or by intramuscular injection (best avoided). It is available in combination with belladona dry extract, caffeine, and paracetamol (Migranil), or with cyclizine and caffeine (Migril). Adverse Effects: Ergotamine may produce nausea, vomiting, abdominal discomfort, diarrhoea, increased thirst, and drowsiness. More serious adverse reactions include weakness, pain or cramps in leg and neck muscles, chest distress or pain, an increase or decrease in heart rate. In sensitive individuals it may cause localized swelling and itching. In rare cases, prolonged use may result in decaying of the fingers and toes (gangrene) due to constriction of blood vessels. Precautions If ergotamine has been taken for a prolonged period of time, it should be discontinued gradually to avoid rebound headaches due to vasodilation. It is contraindicated in patients with peripheral vascular disease (Raynaud's or Burger's disease), and marked atherosclerosis. It should not be taken by patients with high blood pressure and anginal pain of IHO. It should be avoided in cases of peptic ulcer, kidney or liver disease, and infection. In pregnant women it may cause abortion by stimulating the uterus. It should be used cautiously in children. A pain-relieving product without ergotamine may be preferred.
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