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During acute attacks, many patients find it helpful to rest in a quiet, darkened room until symptoms subside A simple analgesic (eg, aspirin, acetaminophen, ibuprofen, or naproxen) taken right away often provides relief, but treatment with extracranial vasoconstrictors or other drugs is sometimes necessary Cafergot, a combination of ergotamine tartrate (1 mg) and caffeine (100 mg), is often particularly helpful; one or two tablets are taken at the onset of headache or warning symptoms, followed by one tablet every 30 minutes, if necessary, up to six tablets per attack and ten tablets per week Because of impaired absorption or vomiting during acute attacks, oral medication sometimes fails to help Cafergot given rectally as suppositories (one-half to one suppository containing 2 mg of ergotamine) or dihydroergotamine mesylate (05 1 mg intravenously or 1 2 mg subcutaneously or intramuscularly) may be useful in such cases Alternatively, prochlorperazine administered rectally (25 mg suppository) or intravenously (10 mg) may be prescribed Ergotamine-containing preparations may affect the gravid uterus and thus should be avoided during pregnancy Sumatriptan, which has a high affinity for serotonin1 receptors, is a rapidly effective agent for aborting attacks when given subcutaneously by an autoinjection device It can also be taken in a nasal form, but absorption is limited, and an oral preparation is available Zolmitriptan, another selective serotonin1

Drug Propranolol1 Amitriptyline Imipramine Sertraline Fluoxetine Cyproheptadine Clonidine Verapamil2

Usual Adult Daily Dose 80 240 mg 10 150 mg 10 150 mg 50 200 mg 20 60 mg 12 20 mg 02 06 mg 80 160 mg

Common Side Effects Fatigue, lassitude, depression, insomnia, nausea, vomiting, constipation Sedation, dry mouth, constipation, weight gain, blurred vision, edema, hypotension, urinary retention Similar to those of amitriptyline (above) Anxiety, insomnia, sweating, tremor, gastrointestinal disturbances Similar to those of sertraline (above) Sedation, dry mouth, epigastric discomfort, gastrointestinal disturbances Dry mouth, drowsiness, sedation, headache, constipation Headache, hypotension, flushing, edema, constipation May aggravate atrioventricular nodal heart block and congestive heart failure

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Solution to Exercise 18-1. Create a Windows application that displays the word Hello in a label, and has a button that changes the display to Goodbye . This exercise is similar to the Hello World exercise from earlier in the chapter. You ve seen how to add a Label control and a Button control, and how to change their Text and font properties accordingly, so setting up that much is simple. What you need now is an event handler to change the text of the label when the button is clicked. You ve seen how to set the Text property elsewhere in this chapter, so that s not too hard. Here is the event handler for the button:

Collection of properties (hash)

Other -blockers have also been used (eg, timolol and metoprolol) Other calcium channel antagonists (eg, nimodipine, nicardipine, and diltiazem) have also been used Botulinum toxin type A injected locally into the scalp is effective for prophylaxis in some patients The antiseizure agents valproic acid (500 1500 mg), gabapentin (900 2400 mg), and topiramate (50 200 mg) are also effective and are detailed in Table 24 3 Valproic acid should be avoided during pregnancy

receptor agonist, has high bioavailability after oral administration and is also effective for the acute treatment of migraine The optimal initial dose is 5 mg, and relief usually occurs within 1 hour A newly developed nasal formulation has a rapid onset of action A number of other triptans are available, including rizatriptan, naratriptan, almotriptan, frovatriptan, and eletriptan Eletriptan (up to 80 mg over 24 hours) is useful for acute therapy and frovatriptan, which has a longer half-life, may be worthwhile for patients with prolonged attacks (up to 75 mg over 24 hours) Triptans may cause nausea and vomiting They should probably be avoided in women who are pregnant and in patients with risk factors for stroke (such as hypertension, prior stroke or transient ischemic attack, diabetes mellitus, hypercholesterolemia, obesity) Triptans are contraindicated in patients with coronary or peripheral vascular disease When used with selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs), triptans may precipitate the potentially fatal serotonin syndrome (agitation, confusion, fever, incoordination, vomiting, tachycardia, and alterations in blood pressure) The neuroleptic droperidol is also helpful in aborting acute attacks Metoclopramide given intravenously may be helpful and is being studied Narcotic analgesics are needed in rare instances, such as meperidine (100 mg intramuscularly) or butorphanol tartrate by nasal spray (1 mg/spray in one nostril, repeated after 3 or 4 hours if necessary) Intravenous propofol in subanesthetic doses may help in intractable cases

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