As a general practitioner, one of the crucial aspects of managing headaches is navigating the realm of migraine prophylaxis. While red flags in headaches demand attention, counseling patients about medication options is equally vital for a successful consultation. Let's delve into specific drug considerations and their side effects:
1. Propranolol - apparently the most common reason for discontinuation of this drug is nightmares. Other things to mention are fatigue, cold hands and feet, and you’ll remember from topic #2 – Erectile dysfunction. Lastly, remember to avoid is asthmatics – because it’s a non-selective beta-blockers and it will interact with your beta agonists like salbutamol – or rather prevent them from working.
2. Amitriptyline - a TCA, which should never be used in anxiety or depression as per the BNF because of risk of fatal overdose, commonly will cause drowsiness which is why it is taken at night. You want to avoid in glaucoma and urinary retention due to its anticholinergic burden. It can also prolong the QT interval. This drug is used both for migraine prophylaxis and tension headache prophylaxis.
3. Topiramate - an anti-epileptic, the main consideration is that it is teratogenic, and so you would either avoid in female or make sure they have effective contraception on board. It can also increase your risk of kidney stones and glaucoma – but through a different mechanism that amitriptyline.
4. Candesartan - an ARB (angio-tension receptor antagonist) normally used in HTN and heart failure. Can cause dizziness or hypotension. You want to monitor U+Es looking for hyperkalaemia after 2 weeks of starting.
5. Sumatriptan - Lastly - for an acute migraine – we often use sumatriptan. It can cause a strange sensation of flushing or heaviness to the face, arms, legs even chest. You want to avoid this drugs in patients with previous stroke/MI/uncontrolled BP. And really importantly – remember it can cause MOH.
It's crucial to note these medication nuances to provide optimal care and avoid potential complications or adverse reactions. Always consult a healthcare professional for personalized guidance and tailored treatment plans.
Should you have any questions or seek further clarification, feel free to drop a comment or reach out via email. Wishing everyone success in managing and alleviating migraine symptoms effectively!
The information contained within this publication was obtained from sources believed to be reliable. Whilst every effort has been made to ensure the accuracy of the material, no responsibility for loss, injury or failure whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the author.
Although every effort has been make to ensure that all owners of copyright material have been acknowledged in the publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.
All readers should be aware that medical sciences are constantly changing and evolving and whilst the author has checked all dosages and guidance are based upon current indications, there may be specific practices and procedures that differ between localities, countries and nations. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practicing.