I. Migranal fact file:

Migranal was introduced by Novartis pharmaceuticals.

Novartis Pharmaceuticals Corporation is the U.S. affiliate of Novartis AG (NYSE:NVS), a world leader in healthcare.

Novartis has core businesses in pharmaceuticals, consumer health, generics, eye care, and animal health. In the U.S., Novartis has quickly achieved a reputation as an industry leader.

II. Migranal Medication

Migranal medication , a combination of ergotamine and caffeine is used to prevent and treat migraine headaches.

Ergotamine is in a class of medications called ergot alkaloids. Ergotamine works together with caffeine by preventing blood vessels in the head from expanding and causing headaches.

Ergot alkaloids: Information

Ergot alkaloids are derived from a common fungus. They are only used to treat migraine and cluster headaches. Two ergot alkaloids commonly used are ergotamine and DHE.

Examples of ergot alkaloids are ergotamine, belladonna alkaloids, and phenobarbital, oral; ergotamine, caffeine, belladonna alkaloids, and pentobarbital, oral; Bellergal-S; Bel-Phen-Ergot; Bellamine; Cafatine PB.

Migraine: Information

A migraine is not just a headache. Although moderate to severe head pain is the most common symptom, there are usually other symptoms that help diagnose frequent bad headaches as a migraine.

Anyone who's ever been diagnosed with migraines knows that they're more than just bad headaches. Migraines can produce any of the following symptoms. Not everyone will experience all of the symptoms, and symptoms may vary from individual to individual and from attack to attack.

Symptoms of Migraine

Symptoms you may have:

• Nausea or vomiting
• Sensitivity to light and/or sound
• Stuffy or runny nose and watery eyes
• Dizziness
• Mood changes
• Tunnel vision or seeing "spots"

Types of pain you may have:

• Pain on one or both sides of the head
• Pain in the back of the neck
• Pain or pressure in the face, eye area, or sinuses
• Pain that disrupts normal activity
• Pain that is aggravated by routine activity

Causes of Migraine

Most experts believe that during a migraine, blood vessels on the surface of the brain expand, causing the area around them to become inflamed and irritate nerve endings. This dilation (expansion) and irritation may account for the pain you experience during a migraine. It may also lead to nausea, sensitivity to light and sound, and other symptoms associated with migraine.

Triggers of Migraine

Migraines have specific triggers, which can be different for each person. Some people seem to have no specific triggers. By familiarizing with potential triggers, you can learn about causes that may contribute to your migraine attacks.

• Food & food additives
  Alcohol (especially red wine), caffeinated beverages, nuts, nitrite/nitrate-preserved foods (hot dogs, pepperoni), smoked or pickled foods.
  
• Light
  Strong or glaring light. Flickering lights from TV or computer screen, strobe or laser lights, or reflections.
  
• Smells/odors
  Intense, specific food odors, cigarette or other smoke, perfumes, cleaning products.
  
• Stress
  Migraine attacks often occur after stress - especially on weekends and holidays. Many people mistake these as tension headaches.
  
• Weather Changes
  High humidity, atmospheric pressure changes, rapid temperature fluctuations, and exposure to extreme heat or cold may bring on migraine attacks. Many people mistake these for "sinus headaches."
  
• Changes in sleeping habits
  Too little, or more often, too much sleep can trigger migraines.
  
• Dieting/hunger
  Any change in eating habits, missed meals, change in schedule or dieting.
  
• Loud noises/sounds
  Sudden or prolonged loud noises.
  
• Motion/travel
  Reaction to motion sickness.
  
• Caffeine
  Having more (and sometimes even having less) caffeine than you are used to can trigger migraines.
  
• Hormonal Fluctuations
  The frequency of women's migraines is sometimes said to be related to hormonal fluctuation, particularly with regard to estrogen. In many women, migraines begin just prior to, or during, their monthly menstrual period, or during treatment with artificial hormones such as birth control pills or estrogen replacement therapy.

Treatment of Migraine

The physician analyzes the patient's migraine history to devise an appropriate treatment program. The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine (called abortive treatment).

• Prophylactic Treatment
  Preventative medication may be prescribed for patients who have frequent headaches (3 or more a month) that do not respond to abortive treatment. Using one medication (monotherapy) is tried first, but a combination of medicines may be necessary. Many of these medications have adverse side effects. If migraines become controlled, the dosage is often reduced or the drug discontinued.
  
  Beta blockers (e.g., propranolol [Inderal], atenolol [Tenormin]) are the preferred medications. These drugs produce an effect on heart rate. They should not be taken by patients with asthma and should be used with caution in patients with diabetes.
  Antiseizure drugs such as valproic acid (Depakote), topiramate (Topamax), and Gabapentin (Neurontin) may be used to treat migraine.
  
  Calcium channel blockers (e.g., Verapamil, Amlodipine [Norvasc]) inhibit artery dilation and block the release of serotonin. They should not be taken by patients with heart failure or heart block.
  
  Tricyclic antidepressants (TCAs; e.g., amitryptaline [Elavil], nortryptaline [Pamelor], desipramine [Norpramin]) block serotonin reabsorption and take 2–3 weeks be effective.
  
  Selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) are usually better tolerated than TCAs, but may not be as effective.
  
  Methysergide maleate (e.g., Deseril, Sansert) may be prescribed for patients with frequent, severe migraines.
  
• Abortive Treatment
  Mild, infrequent migraines may be relieved using over-the-counter medication. Severe headaches with accompanying symptoms may require prescription medication.
  
  During a migraine, people often prefer to rest or sleep alone in a dark, quiet room. Applying cold packs to the head or pressing on the bulging artery in front of the ear on the painful side of the head may provide temporary pain relief.
  
  Analgesics (e.g., aspirin, ibuprofen, acetaminophen) provide symptomatic relief from headache pain and should be taken at the first sign of a migraine. They are most effective for infrequent migraines (less than 3 a month) and breakthrough headaches (i.e., headaches that occur despite using prophylactic medications).
  
  Frequent use of analgesics (i.e., more than 4 times a week) can cause rebound headaches and may interfere with prophylactic treatment. Acetaminophen is sometimes combined with other drugs to form an analgesic compound (e.g., Midrin).
  
  Serotonin receptors (e.g., Imitrex, Amerge, Axert, Zomig), are fast acting, usually well-tolerated medications commonly used to treat migraines. They are available in oral, injectable, and nasal spray forms and can be taken any time during the headache.
  
  Ergots (e.g., Cafergot, Mioranal) may be administered orally or as a suppository and is often combined with antinausea drugs, such as prochlorperazine (Compazine). This medication should be taken at the first sign of a migraine and may not be effective if the headache has moved into the throbbing stage.
  

Prevention

Avoiding triggers, managing stress, and taking prophylactic medications can help prevent migraines. Keeping a migraine journal can help identify triggers and gauge the effectiveness of preventive measures. Patients should monitor the following:

• Activities
• Emotional factors (e.g. stressful situations)
• Environmental factors (e.g., weather, altitude changes)
• Foods and beverages
• Medications (over-the-counter and prescription)
• Migraine characteristics (e.g., severity, length)
• Physical factors (e.g., illness, fatigue)
• Sleep patterns
• Stress management techniques (e.g., biofeedback, hypnosis) and stress-reducing activities (e.g., meditation, yoga, exercise) may help prevent migraines.

Cluster Headache: Information

A cluster headache is a rare type of headache that is more common in men. Cluster headaches start suddenly. The pain is usually behind or around one eye and is very severe. The eye and nose on the same side as the pain may become red, swollen and runny. Cluster headaches also cause restlessness. These headaches can be frightening to the sufferer and his or her family.

A cluster headache can last a few minutes or several hours, but it usually lasts for 30 to 45 minutes. Cluster headaches typically occur at the same time each day for several weeks, until the "cluster period" is over. Cluster periods usually last 4 to 8 weeks and may occur every few months. At other times, no cluster headaches will occur.

Causes of Cluster Headaches

The cause of cluster headaches is not known. Cluster headaches do not appear to be related to other illnesses or to diseases of the brain. They do not seem to run in families.

Treatment for Cluster Headaches

• Several treatments are available for cluster headaches. It is important to work with your doctor to talk about side effects of different medicines, pick the right treatment for you and set up a schedule for taking the medicines your doctor prescribes.
• Your doctor will probably prescribe 2 medicines. One medicine is taken regularly during a cluster period to reduce the number of headaches. In order for the medicine to work, the level of the drug in your blood must be high at the time your attacks usually start.
• The second medicine is taken to relieve the pain when a cluster headache occurs. Attacks begin too quickly for you to reach medical help. You must be ready to take this medicine as soon as an attack begins. You may want to teach family members about your headaches and medicines so that they will be able to help you when you have an attack.
• Medicines taken by mouth work too slowly to give relief for cluster headaches. For this reason, your doctor may prescribe a medicine that is taken by inhaler, as an injection (a "shot") or as a rectal suppository. Other treatments that work for some people are rapidly breathing pure oxygen through a mask or using a local anesthetic (numbing medicine) in their nose.
  

• Side effects of Beta-Blockers include gastrointestinal upset, insomnia, low blood pressure (hypotension), slowed heart rate (bradycardia), and sexual dysfunction. Some beta blockers pass into breast milk and may cause problems in nursing infants.
• Side effects of anti-seizure drugs include nausea, gastrointestinal upset, sedation, liver damage, and tremors.
• Side effects of Calcium Channel Blockers include constipation, flushing, low blood pressure, rash, and nausea.
• Side effects of Tri-cyclic Antidepressants include the following:
• Constipation
• Dry mouth
• Low blood pressure (hypotension)
• Increased heart rate (tachycardia)
• Urinary retention
• Sexual dysfunction
• Weight gain

High doses of TCAs have been implicated in seizures, stroke, and heart attack. Abrupt discontinuation of these medications may cause headache, nausea, and malaise, and may intensify side effects.

• Side effects of SSRI's include nausea, insomnia, sexual dysfunction, and loss of appetite.
• Side effects of Methysergide maleate include insomnia, drowsiness, lightheadedness, and hair loss. This drug should not be used by patients with coronary artery disease and must be discontinued for 3–4 weeks after 4–6 months of use because it can cause retroperitoneal fibrosis, a condition in which the blood vessels in the abdomen thicken, which reduces blood flow to organs.
• Side effects caused by aspirin and ibuprofen (e.g., Advil, Motrin) include gastrointestinal upset and bleeding. These drugs should be taken with food and used with caution. Ibuprofen is available in suppository form, which can be useful if the migraine is accompanied by severe nausea and vomiting.
• Side effects of Serotonin receptors include dizziness, drowsiness, flushing, discomfort, tingling, and nausea.
• Side effects of ergots include gastrointestinal upset, dizziness, stroke, and high blood pressure (hypertension). Ergots should not be taken by patients with heart, vascular, liver, or kidney disease.

Side effects of Ergot Alkaloids

Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your health care provider if you have any side effects that continue or get worse.

Serious (report these to your health care provider right away): Chest pain, vision problems, confusion, anxiety, itchy skin, depression, strange feelings in or discoloration of fingers or toes, swelling, breathing problems, body aches, cold hands or feet, skin blisters, weakness, fast or slow heartbeat.

Other: Dizziness, diarrhea, nausea.

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

http://www.pharma.us.novartis.com/

http://www.1meds.com/Avamigran.html

http://www.migrainehelp.com/2.understanding_migraine/2.3.migraine_causes.html

http://www.neurologychannel.com/migraine/treatment.shtml

http://familydoctor.org/035.xml

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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