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MEDICATION FOR TREATING HEADACHE: MOOD-ALTERING DRUGS-TREATING HEADACHE WITH SPECIALIZED DRUGS
In many headache situations, mood-altering medications and analgesics are either inappropriate or ineffective and these situations require specialized drugs. These specialized drugs do not actually affect the ability to feel pain, as do analgesics, but instead counteract the abnormality considered responsible for the development of the headache.
In migraine, for example, there is vasodilation, an abnormal widening of blood vessel diameter. Drugs that constrict these dilated blood vessels often relieve the migraine headache, although the reason for their effectiveness may not be confined to vasoconstriction alone. The vasoconstrictors most often used in the treatment of migraine are prepared from the plant fungus called ergot. This fungus grows on a number of grains, particularly rye. Many drugs are derived from ergot, and the form most frequently used for the treatment of migraine is called ergotamine tartrate. Ergotamine tartrate can be prepared to be taken by a variety of routes: oral, rectal, subcutaneous, sublingual (under the tongue), or by inhalation.
Among the complications associated with ergot overdosage are hallucinations and seizures. Severe constriction of blood vessels throughout the body may also occur when too much ergot is taken. A report in Science magazine* suggests that the bizarre behavior attributed to witchcraft in Salem, Massachusetts, may have resulted from ergot poisoning due to contaminated rye. The drug LSD (lysergic acid diethylamide) is chemically related to ergot.
The ergot-containing drugs are most often used to stop, or abort, rather than prevent, a migraine headache.
Methysergide (Sansert) is another specific antimigraine medication, but it is used in the preventive approach rather than the abortive approach. It has little value once a headache has begun. It, like ergot, is chemically related to LSD.
Another drug currently being used in migraine prevention was initially used for heart patients suffering from coronary artery disease. This drug, called propranolol (Inderal), was found quite by accident to prevent migraine attacks in some of the heart patients who also suffered from migraine.
Another specific type of medication used in certain types of headaches are the muscle relaxants, often used in combination with other drugs to treat the headache produced by muscle contraction. The muscle contraction headache is frequently called the tension headache, and much of the pain in this disorder results from contraction of the muscles of the neck, scalp, and face. Drugs that relieve these muscle spasms may help alleviate the tightening tension and control pain.
Many more drugs useful for treating headache will be discussed in the appropriate sections of the chapters covering the specific headache conditions.
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