NSC2500 Report: Understanding Migraine, Triptan Pharmacology & Care

This report provides an overview of migraine, a common neurological condition, and the use of triptans for its treatment. It discusses the pathophysiology of migraine, including the role of the trigeminovascular system and the involvement of serotonin receptors. The report details the pharmacology of triptans, including their mechanism of action, pharmacokinetics, and routes of administration. It also highlights precautions, side effects, and potential drug interactions associated with triptan use. Furthermore, the report explores other interventions such as magnesium-rich foods, acupuncture, and biofeedback therapy. It emphasizes the importance of lifestyle modifications, including regular sleep, healthy diet, and stress management, in preventing migraine episodes. The role of nursing staff in educating patients about these aspects is also discussed. The report concludes that migraine can be effectively managed with appropriate medication, interventions, and preventive measures.

Running Head: REPORT 0
Biology

REPORT 1
Abstract
Migraine is a syndrome which involves neurovascular pain accompanied with
changes in the processing of central neural. It involves the triggering of the
trigeminovascular system which cause the inflammation and painful sensation. Triptan is a
part of family of tryptamine drug used in the treatment of migraine headaches. They help in
broad spectrum headaches which involves immense discomfort and pain and involved with
the neurological tension. The drug binds to the receptors which are present in the blood
vessels, and the nerve ending in the brain. This results in inhibition of the pain and the
sensory inflammations. They have the affinity majorly for 1B and 1D receptor but not for
other receptors. Sumatriptan drug is usually administrated using four major ways namely
oral, subcutaneous method, intranasal and suppositories method. They are highly
contraindicated for the patients with already existing conditions of cardiovascular disease
such as hypertension, recent incident of stroke, coronary spasms, Raynaud’s disease and
other major conditions. Moreover, how the triptan medication and the basic drug affects the
receptors and relieves the pain. Regular and uninterrupted sleep is the key to prevent further
episodes as it relaxes the mind and washes away the unwanted stress and strain in the mind
and brain, which is one of the key factors for the delayed recovery. These treatments are well
approved and functional however, person must take several precautions to prevent the
condition by making modification in diet by having healthy and regular meals, regular
uninterrupted sleep, daily physical exercise or workouts and most importantly avoidance of
stressful work and scenarios.

REPORT 2
Contents
Abstract......................................................................................................................................1
Introduction................................................................................................................................3
Pathophysiology.........................................................................................................................3
Pharmacology.............................................................................................................................3
Drug naming...........................................................................................................................3
Pharmacodynamics.................................................................................................................3
Pharmacokinetics....................................................................................................................4
Route of Administration.........................................................................................................4
Precautions and Side Effects..................................................................................................4
Drug Interaction.........................................................................................................................5
Other interventions.....................................................................................................................5
Clinical practice.........................................................................................................................5
Conclusion..................................................................................................................................6
References..................................................................................................................................7

REPORT 3
Introduction
Migraine is a combination of different neurological condition and symptoms like
unbearable pain and sensation accompanied by severe headache in specific part of head. It is
usually caused due to change in hormones, stress, lack of physical activity and unhealthy diet.
However, the actual causes are still unknown but these were the possible factors for the same.
Painkillers and relivers are the only medicine that works so far. The highly recommended
medicine is triptans which works as serotine receptor agonist. Agonist is associated with the
receptor and works in the brain like a chemical serotonin. It calms down the pain in the
nerves and ease the condition (May, 2016).
Thus, report discusses about the migraine and the mechanism of drug triptan. It covers the
pharmacology and pharmacokinetic of drug and the route of administration by which the drug
can be intervened into the patient. It also educates about the side effects accompanied with
the drug and what all things should be avoided while on medication with triptan.
Pathophysiology
Migraine is a syndrome which involves neurovascular pain accompanied with
changes in the processing of central neural. It involves the triggering of the
trigeminovascular system which cause the inflammation and painful sensation. Moreover, it
has been studied that the dilation and the infected intercranial and cephalic arteries cause
the headache. The sympathetic nervous system gets activated which results in the pain
(Goadsby, 2017).
Pharmacology
Drug naming
Triptan is a part of family of tryptamine drug used in the treatment of migraine
headaches. They help in broad spectrum headaches which involves immense discomfort and
pain and involved with the neurological tension. These drugs act as agonist which means
binding of the drug to the receptor and activate it to produce a biological response. The
receptors in this case are five hydroxy tryptamine serotonin receptor 1B and 1D. Initially the
triptan was manufacture in form of sumatriptan under the brand name Imitrex (Edvinsson,
2012).

REPORT 4
Pharmacodynamics
The drug binds to the receptors which are present in the blood vessels, and the nerve
ending in the brain. This results in inhibition of the pain and the sensory inflammations.
Triptans have the affinity majorly for 1B and 1D receptor but not for other receptors. These
receptors are G protein type of receptors which includes seven transmembrane receptors to
carry out the process. The process starts with the constriction of the cranial vessels which are
causing the pain when the drug namely sumatriptan or rizatriptan is consumed. Then occurs
inhibition of the neuropeptide which is vasoactive in nature and is released by the intracranial
nerves. Finally, nociceptive neurotransmission is inhibited in the brainstem and upper
cervical area (De Felice, 2010).
Pharmacokinetics
Sumatriptan has relatively low bioavailability of oral medication which accounts for
around 14 percent whereas in the case of rizatriptan medication the rate of absorption of the
drug is much faster. It has been studied that the half-life of drugs like naratriptan, rizatriptan
is longer than commonly used sumatriptan which has 2 hours of half-life. The ability to
effectively cross the barrier of blood and brain helps in treating the issues of migraine more
efficiently and supportively. It also decreases the chances of reoccurrence of episodes of
migraine which is difficult and time consuming with other medications (Reddy, 2013).
Route of Administration
Sumatriptan drug is usually administrated using four major ways namely oral,
subcutaneous method, intranasal and suppositories method. Oral method involves
administration of drug through mouth in the form of pills, tablets, capsules and syrups.
Subcutaneous method involves medication through injections which is administrated under
the skin. Intranasal uses nasal sprays, aerosols and nasal drops to administer the drug (Derry,
Sumatriptan (oral route of administration) for acute migraine attacks in adults, 2012). Lastly
suppositories use the intervention of drug through rectal or vaginal pathway. The dose
provided through oral and intranasal pathways are highly preferred and shows effective
results as compared to the rectal pathway which is not much used by the patients. The best
results in the severe pain can be seen from the subcutaneous method as it provides fast relief
with the dose of 6 mg when compared to oral method which requires a dose of 50 mg (Derry,
Sumatriptan (all routes of administration) for acute migraine attacks in adults‐overview of
Cochrane reviews, 2014).

REPORT 5
Precautions and Side Effects
Triptans are highly contraindicated for the patients with already existing conditions of
cardiovascular disease such as hypertension, recent incident of stroke, coronary spasms,
Raynaud’s disease and other major conditions. Most of the triptan drugs are not
recommended to the women who are pregnant or on breastfeeding (Johnston, 2010).
Moreover, children of age less than 18 years are also not prescribed with some drugs. A
correct dose according to requirements must be given to the patients or else it may lead to
adverse effects such as reoccurrence and partial recovery in the patients. In case of the person
with existing cardiac issues, the drug may increase the risk of incidence like cardiac or
coronary spasms (de Vries, 2020).
Drug Interaction
It has been studied that the interaction of triptan with the serotonergic drug like SNRI,
Monoamine oxidase inhibitor, ergot alkaloid and SSRI, has increased the risk rate of
condition like serotonin syndrome which involves the alteration of mental stability and
congenial ability. Moreover, ergot alkaloids and triptan are contraindicated to eliminate the
risk of cardiac or coronary spasms. Along with it, several antidepressant drugs and inhibitor
drugs like linezolid, phenelzine, selegiline, procarbazine are avoided as they may cause
adverse effects (Spielmann, 2018).
Other interventions
It has been studied that the migraine patients have low magnesium content in their
bodies, so to compensate for that and to relieve the pain magnesium rich food can be eaten
such as bananas, tea, coffee, nuts, vegetables, spices, meat and dairy products. They have rich
magnesium content which naturally affects the muscles of the body and relaxes them.
Magnesium dose of minimum 600mg for a period of three to four months will show
significant effect. Apart from this there are several acupuncture and yoga practices that can
be intervened to relaxes the nerves and to release the strain in the muscles and brain. It has
been studied that the patient with severe headache when give twelve session for a period of
three months showed decrease in migraine episodes and use of drugs and medication.
Biofeedback therapy is also effective as it relaxes the muscles and releases the tension and
strain by using sensor in areas like jawlines, shoulders and back. Butterbur and feverfew with
dose of 150 mg per day have been studied had have showed significant effects in reduction if

REPORT 6
migraine pain. These are herbal supplements that can be taken in addition to the therapeutic
medication (Linde, 2016).
Clinical practice
Nursing staff or the primary care giver plays the significant role in handling the cases
of the migraine. Since, it involves less of therapeutic treatment and more of precaution and
careful measure, the nursing staff and healthcare workers are more involved with the patients.
Their prime duty involves educating the patient about the need of proper diet which involves
elimination of processed food consumption, alcohol and smoking. Apart from that screening
of the daily activity such as sleep patterns and cycle, daily physical activity and regular meal
intake is screened by the nurses which helps in making alterations in the patient’s mediation.
In case of the episode of migraine pain, additional relief can be provided by intervening
vitamin B complex capsule after recommendation. Moreover, cold compress and massages at
the cervical area can be followed to alleviate the pain (May, 2016).
Conclusion
Hence, it can be concluded form the discussion that the migraine is very common
disease that is quite prevalent in the society. However, with several user-friendly medication
and interventions it can be treated and prevented effectively. The report discusses about the
different aspects of migraine and the highly recommended second-generation medication
called as triptan. It shows how the migraine pain effects our brain and nerves. Moreover, how
the triptan medication and the basic drug affects the receptors and relieves the pain. Regular
and uninterrupted sleep is the key to prevent further episodes as it relaxes the mind and
washes away the unwanted stress and strain in the mind and brain, which is one of the key
factors for the delayed recovery. These treatments are well approved and functional however,
person must take several precautions to prevent the condition by making modification in diet
by having healthy and regular meals, regular uninterrupted sleep, daily physical exercise or
workouts and most importantly avoidance of stressful work and scenarios.

REPORT 7
References
De Felice, M. O. (2010). Triptan‐induced latent sensitization: A possible basis for medication
overuse headache. Annals of neurology, 67(3), 325-337.
de Vries, T. V. (2020). Pharmacological treatment of migraine: CGRP and 5-HT beyond the
triptans. Pharmacology & Therapeutics, 107528.
Derry, C. D. (2012). Sumatriptan (oral route of administration) for acute migraine attacks in
adults. Cochrane Database of Systematic Reviews(2).
Derry, C. D. (2014). Sumatriptan (all routes of administration) for acute migraine attacks in
adults‐overview of Cochrane reviews. Cochrane Database of Systematic Reviews(5).
Edvinsson, L. V. (2012). Basic mechanisms of migraine and its acute treatment.
Pharmacology & therapeutics, 136(3), 319-333.
Goadsby, P. H.-O. (2017). Pathophysiology of migraine: a disorder of sensory processing.
Physiological reviews, 97(2), 553-622.
Johnston, M. a. (2010). Triptans for the management of migraine. Drugs, 70(12), 1505-1515.
Linde, K. A. (2016). Acupuncture for the prevention of episodic migraine. Cochrane
Database of Systematic Reviews(6).
May, A. a. (2016). Chronic migraine: risk factors, mechanisms and treatment. Nature
Reviews Neurology, 12(8), 455.
Reddy, D. (2013). The pathophysiological and pharmacological basis of current drug
treatment of migraine headache. Expert review of clinical pharmacology, 6(3), 271-
288.
Spielmann, K. K. (2018). Pregnancy outcome after anti-migraine triptan use: A prospective
observational cohort study. Cephalalgia, 38(6), 1081-1092.