Nursing Pharmacology Chapter 23:  Ergot Alkaloids

Ergot Alkaloids: Clinical Pharmacology

• Migraine

  • "Migraine 101:  A 3-Step Guide to Managine Headaches"

    Cowan R "Migraine 101:  A 3-Step Guide to Managing Headaches" "Migraine sufferer and director of the Stanford Headache Clinic, Robert Cowan, MD, provides a closer look at migraines and a helpful guide on how to manage this, most common form, of headaches." StanfordHospital:  https://www.youtube.com/watch?v=jHffEt-MXjI

  • Clinical Presentations

    • Often accompanied by brief aura (visual scotomas, hemianopia, beach abnormalities

    • Severe, throbbing, usually unilateral headache (few hours to a few days in duration)

    • Familial disease

      1. More common in women

      2. Onset: may be in early adolescence and onset appears less common in older patients

      3. Migraine associated with stress

      4. Headache frequency ranges from one or more per week to once a year

  • Migraine Pathophysiology

    • Migraine Headaches

      Barad M "Stanford Hospital's Meredith Barad, MD, Discusses Migraine Headaches" "Migraine is an intense and often debilitating type of headache which affects nearly 24 million Americans every year.  This talk focuses on the causes of migraine and how it is diagnosed and differentiated from other kinds of headache, as well (as) current treatments for this condition." StanfordHospital:  https://www.youtube.com/watch?v=XJWMKkRdxZI

    •  Vasomotor mechanism for migrane has been suggested by:

      1. Increased temporal artery pulsation magnitude

      2. Pain relief by ergotamine which decreases artery pulsations

    • Migraine attack associated with:

      • Sterile neurogenic perivascular edema

      • Inflammation 

    • Serotonin involvement has been suggest in migrane-type headache:

      • Throbbing headache is associated with decreased serum and platelet serotonin

      • Presence of serotonergic nerve terminals at meningeal blood vessels

      • Antimigraine drugs influence serotonergic neurotransmitter

      • Some migraine chemical triggers may work through serotonin pathways, i.e. decreasing estrogen (associated with the menstrual cycle) and increased prostaglandin E₁.

Burkhalter, A, Julius, D.J. and Katzung, B. Histamine, Serotonin and the Ergot Alkaloids (Section IV. Drugs with Important Actions on Smooth Muscle), in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 261-286.;  New "Triptans" and Other Drugs for Migraine, The Medical Letter, Vol. 40 (Issue 1037); October 9, 1998