WOMEN

PRESENTED BY

SOWMYA KONDLA13GD1R0017IV-I B.PHARMACY

UNDER THE GUIDANCE OF

Mr. P. KISHORE KUMAR(Assistant Professor)

CHILKUR BALAJI COLLEGE OF PHARMACY(Affiliated to JNTU, Hyderabad, Aziz Nagar, Moinabad,

Telangana -500085)

INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY GENETICS AND MIGRAINE ROLE OF HORMONES IN MIGRAINE MIGRAINE TRIGGERING FACTORS COMPLICATIONS TREATMENT PREVENTION CONCLUSION REFERENCES

CONTENTS

INTRODUCTION

Migraine is a common, chronic, predominantly female neurovascular disorder.

Painful cases of headaches are recorded by ancient Egyptians earlier before 1200 B.C.

It is characterized by vascular headaches ranges from moderate to severe of about 4 to 72 hours.

It can be inherited or by external stress factors like stress, certain food, weather changes, smoke, fatigue, etc.

Migrainuers have often have colder hands and feet, the prevalence of motion sickness is much higher in most of the migrainuers.

AURA AND PAIN

CLASSIFICATION OF MIGRAINE

1. CLASSIC MIGRAINE (OR) MIGRAINE WITH AURA Classic Migraine is a genetic neurological disease. These early symptoms are also called as Prodome. Typical aura consists of visual or sensory or speech symptoms. It’s occurrence is based on genetics and overweight.

2. COMMON MIGRAINE (OR) MIGRAINE WITHOUT AURA

It is usually associated with nausea, vomiting, sensitivity to light, etc., with severe headache.

It last for 4 to 72 hours with moderate or severe intensity, aggravation by physical activity and associated with photophobia and phonophobia.

OTHER TYPES OF MIGRAINE

Facial migraine (or) Lower-half headache.

Status Migrainosus, lasts for more than 72 hours.

Basilar artery migraine, include visual disturbances, giddiness, loss of balance, slurred speech, etc.

Hemiplegic migraine, resembles as stroke and arm or leg is completely paralyzed for few hours.

Opthalmoplegic migraine, is complete paralysis of eyes move out of alignment.

SIGNS & SYMPTOMS Migraine with aura may have some of the following

sensory symptoms. Seeing flashing lights and floating lines.

Developing temporary peripheral blindness, numbness or tingling in the face or hands.

Distorted sense of smell, taste, touch, mental confusion.

Migraine without aura will not have sensory symptoms.

Worldwide, migraines affect nearly 15% or approximately one billion people.It is more common in women (19%) than men(11%).Rates of migraines are slightly lower in Asia and Africa.In United states women(18%) and men(6%) get migraine

every year.Europe migraines affect 12-28% of people yearly.Migraines most commonly start between 15 and 24 years of

age and occur more frequently in those 35 to 45 years of age.

EPIDEMIOLOGY

PATHOPHYSIOLOGY

Is assumed that following process underlie the occurrence of the migraine1. Cortical Spreading Depression (CSD)2. Activation of Trigeminal Vascular System3. Sensitization of Peripheral and Central areas of brain

GENETICS AND MIGRAINETransmission of migraine from parents to children has been reported early as 17th century with positive family history.

Serotonin Theory It states that during migraine headache there is a decrease in platelet serotonin theory which cause Trigeminal system to release pain mediating neuropeptides.

Hypothyroidism Low functioning thyroid glands are one of the causes of migraine attacks. Slowed metabolism and circulation seen in hypothyroidism leads to the retention of water, mucin which cause blood vessels and tissues in brain to swell and cause pain.

ROLE OF HORMONES IN MIGRAINE CHANGES IN ESTROGEN

MENSTRUAL MIGRAINE

MIGRAINE TRIGGERING FACTORS

Hormonal changes, mainly drop in estrogen levels.

If parents have migraine.

Skipping meals or fasting, alcohol, aged cheeses, salty foods and processed foods.

Sensory stimuli like bright lights, sun glare, loud sounds. Unusual smells include perfume, etc.

A change of weather or the barometric pressure can prompt migraine.

COMPLICATIONSAccording to the IHS, there are five complications of migraines.

1. Chronic migraines are daily headaches and mild.

2. Status Migrainosus continues for more than 72 hours.

3. Persistent aura includes symptoms like loss of vision and tinnitus.

4. During the migraine with aura, a patient also has a stroke in the area of the brain.

5. A migraine seizure is an epileptic seizure that follows a migraine with aura.

TREATMENT

PAIN RELIEVING MEDICATIONS

• This include NSAIDS, triptans, ergot alkaloids, anti- emetics, opiods, glucocorticoids, Aspirin.

• Drugs marketed specifically for migraines, such as the combination of Acetaminophen, aspirin and caffeine.

PROPHYLAXIS

• It reduces the frequency, duration and intensity of migraines. Ex: Naproxen (500mg twice daily) Mefenamic acid (500mg thrice daily)

SUPPLEMENTS

• Magnesium supplements reduce migraine, as Magnesium levels in the brain are low during migraines. Taken in a dose of 360mg daily.• Vitamin E, in dose of 400 IU daily for 5 days.

ESTROGEN THERAPY

• Hormonal replacement therapy is medical treatment in surgically perimenopausal, menopausal and postmenopausal women.• Its goal is to mitigate caused by diminished circulating estrogen and progesterone hormones in menopause.

TRIPTANS

Effective regimens are Sumatriptan(25mg, 3/day), Naratriptan (1mg, 2/day)Fravatriptan (2.5mg, 2/day) and Zolmatriptan (2.5mg 2/day).

PREVENTION

• Preventive treatments of migraine include medications, nutritional supplements, lifestyle alterations and surgery. • Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe migraine attacks.

• Medications include anti- hypertensive's like beta-blockers, calcium channel blockers, anti-depressants like gabapentin, valproic acid, topiramate and anti-histamines like diphenhydramine and cyproheptadine.

CONCLUSION Prevalence of migraine is more in women due to fluctuations in the female hormone estrogen levels.

The use of hormonal replacement therapy, combined oral contraceptives will improve the migraineur condition.

So, while diagnosing and prescribing drugs to treat migraine in women, hormone levels should be carefully monitored.

In future, research should be focused on estrogen related pathophysiology and treatment studies in female migraineurs.

REFERENCES

1. Indian journal of pharmacology and toxicology, 17 (1) 2016, 27-36.

2. Victor TW, Hu X, Campbell JC, et al. Migraine prevalence by age and sex in the US. Cephalgia 2010;30:1065-1072.

3. Lay CL, Broner SW. Migraine in women. NeurolClin. 2009;27;503-511.

4. Macgregor EA. Estrogen and attacks of migraine with and without aura. Lancet Neurol. 2004;3;354-361.