analeptics are benzphetamine (Didrex), deithylpropion (Tenuate), felfluramine
(Pondimin), and phentermine (Phentride). Caffeine is also a stimulant found in
many beverages, foods, OTC drugs, and prescription drugs. Caffeine is found
in many drugs including Anacin, Excedrin, Cafergot, Fiorinal, and Midol.
See amphetamine-like drugs provided in the Appendix. Detailed tables show
doses, recommendations, expectations, side effects, contraindications, and more;
available on the book’s Web site (see URL in Appendix).MIGRAINE HEADACHES
Migraines are a debilitating neurovascular disorder that affects 28 million peo-
ple over the age of 11. The cause of migraines is not clearly understood although
research indicates the expansion of blood vessels and the release of certain
chemicals—such as dopamine and serotonin—causes inflammation and pain.
Dopamine and serotonin are found normally in the brain. A migraine can occur
if an abnormal amount of these chemicals are present or if the blood vessels are
unusually sensitive to them.
Patients who have migraines experience intense, throbbing, headache pain
which is often accompanied by nausea, photophobia (sensitivity to light), phono-
phobia (sensitivity to sound), and temporary disability. Migraines are sometimes
preceded by an aura such as a breeze, odor, a beam of light, or a spectrum of
colors. Migraines can occur on one side of the head (unilateral) and the pain is
frequently reported as pulsating or throbbing.
Treatment of migraine is divided into prevention and symptomatic relief.
There are six categories of medication used to prevent migraines. These are
blood-vessel constrictors and dilators (see Chapter 26), antiseizure drugs (dis-
cussed later in this chapter), antidepressants (discussed later in this chapter),
beta-blockers (see Chapter 26), and analgesics (see Chapter 16). Patients are
given a selected combination of these medications to prevent migraines. The
prescriber determines the most effective combination for each patient based on
the patient’s response to these medications.
Commonly prescribed medications to prevent migraines are amitriptyline,
divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine,
diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide.
Methysergide is particularly effective. However, there are side effects that might
make this drug less tolerable.
Bringing about symptomatic relief from the pain associated with migraines
and other migraine symptoms is achieved by prescribing antiemetics (anti-
nausea, see Chapter 18), ergot alkaloids and related compounds, NSAIDS (see
Chapter 12), and other analgesic (nonopioids); opioids, and triptans (see chart).(^272) CHAPTER 15 Nervous System Drugs