Haloperidol and lorazepam for the treatment of nausea and vomiting associated with the treatment of intractable migraine headaches

Can migraine prophylaxis prevent acute mountain sickness at high altitude?

Acute mountain sickness (AMS) develops in people trekking at high altitude. The underlying mechanism is vasodilation due to low pressure of oxygen. However, individual susceptibility for AMS is unknown, thus, one cannot predict when or to whom it happens. Because AMS usually begins with headache, and because migraineurs are more vulnerable to AMS, we studied by the literatures review on the mechanism and clinical features in common, and assessed the treatment modalities for both disorders. This led to us the following hypothesis that, migraine prophylaxis may prevent or delay the onset of AMS at high altitude. Clinical features of AMS include nausea or vomiting when it progresses. Hypobaric hypoxia, dehydration or increased physical exertion trigger or aggravate both disorders. In migraine, cerebral vasodilation can happen following alteration of neuronal activity, whereas the AMS is associated with peripheral vessel dilation. Medications that dilate the vessels worsen both conditions. Acute treatment strategies for migraine overlap with to those of AMS, including drugs such as vasoconstrictors, or other analgesics. To prevent AMS, adaptation to high altitude or pharmacological prophylaxis, i.e., acetazolamide has been recommended. This carbonic anhydrase inhibitor lowers serum potassium level, and thus stabilizes membrane excitability. Acetazolamide is also effective on specific forms of migraine. Taken together, these evidences implicate that migraine prophylaxis may prevent or delay the onset of AMS by elevating the threshold for high altitude.

Pharmacological studies of the aqueous extract of Sapindus trifoliatus on central nervous system: possible antimigraine mechanisms

The aqueous extract of pericarp of fruits of Sapindus trifoliatus (ST) Linn., family Sapindaceae was evaluated for its potential effects on central nervous system in mice. The extract at doses 20 and 100 mg/kg, i.p. significantly (p < 0.001) reduced the spontaneous locomotor activity and at 100 mg/kg, increased the thiopental-induced sleeping time. In rota-rod motor co-ordination test, ST at 100 mg/kg, i.p. significantly (p < 0.05-0.01) reduced the endurance time. Further ST exhibited no protection against maximal electroshock (MES)- and pentylenetetrazole (PTZ)-induced convulsions in mice. In receptor radioligand binding studies, ST exhibited affinity towards dopaminergic, alpha-adrenergic and muscarnic receptors. The findings suggest that, ST may possess principles with potential neuroleptic properties.

Digestive Enzyme Adjunct to Oral Headache Medication to Improve Absorption and Reduce Vomiting

Objective:

To report a case in which a digestive enzyme complex (Nature's Plus Digestive Enzymes: pancreatin, pepsin, ox bile extract, malt diatase, and papain) apparently improved the absorption and efficacy of an oral headache medication and alleviated vomiting associated with the headache.

Case Summary:

A 47-year-old white woman with a history of adverse drug reactions and allergies had been experiencing one to four disabling headaches per week for 2 years. One or two headaches each week would be accompanied by vomiting. This patient experienced adverse effects with most standard headache medications. For 40 months since taking a complex of digestive enzymes as an adjunct to her headache medication, the patient's vomiting has been eliminated, and her postheadache symptoms have been reduced.

Discussion:

Altered digestive processes are a common finding in severe headache episodes. Exogenous digestive enzymes may facilitate the absorption of oral medication during gastric disruption and consequently increase drug efficacy and the relief of symptoms.

Conclusions:

Digestive enzymes merit further study to ascertain their effectiveness in increasing the absorption and efficacy of oral medications prescribed for headaches accompanied by emesis.

A new approach to emergency department therapy of migraine headache with intravenous haloperidol: a case series

Six case reports are presented that describe the use of intravenous haloperidol for patients with migraine headache. Haloperidol was used in a dose of 5 mg following a 500- to 1000-cc bolus of normal saline. Headache was completely or substantially relieved in all six patients 25 to 65 min after administration of haloperidol; the median time until discharge was 51 min. Side effects were minimal or nonexistent. None of the patients returned to the Emergency Department (ED) for any reason over the next 48 h. It is concluded that haloperidol may play a role in treatment of migraine headache in the ED, and that further study is warranted.