2. Migraine Meds

Question 1

What are the sx of a migraine?

Answer 1

• bilateral, unilateral, throbbing pain, nausea

- usually preceded by an aura (usually visual)

Question 2

What are some triggers that can cause migraines?

Answer 2

• weather
• missing a meal
• stress
• food
• menstruation
• crying

Question 3

What are 3 types of management for migraines?

Answer 3

• non-opiod analgesics (NSAIDs)
• Excedrin (acetaminopen, ASA, caffeine combo)
• occasionally opiods (for refractory migraines, but should be last resort)

Question 4

____% of migraine sufferers report some disability.

Answer 4

80%

Question 5

____% of migraine sufferers require bed rest.

Answer 5

33.3%

Question 6

What are ergot alkaloids?
What are they used for?
Give 2 examples.

Answer 6

• non-specific serotonin agonists used for acute migraine headaches
• ergotamine, dihydroergotamine

Question 7

What are the side effects of ergot alkaloids?

Answer 7

• liver disease
• rebound headache with frequent use
• CV disease –> arteriolar vasoconstriction
• Poor peripheral circulation!!

Question 8

What is Raynaud’s disease? How do ergot alkaloids contribute?

Answer 8

A severe reduction in circulation in the extremities due to cold or emotional stress.
Since peripheral circulation is already compromised, it can make this condition even worse.

Question 9

What are “triptans” used for?

What is the mechanism of action?

Answer 9

• medications used for acute migraine headaches
• serotonin receptor agonist
• side effect similar to ergot alkaloids

Question 10

What are the different dosage forms of triptans?

Answer 10

• pill
• nasal spray
• sublingual (fast and effective action)

Question 11

What are the pros and cons of triptains?

Answer 11

pro - very effective and also relieves nausea

con - very expensive

Question 12

What other medications should not be taken with triptans? Why?

Answer 12

1. MAOI or SSRI antidepressants
   - can cause serotonin syndrome –> restlessness, muscles twitch, hyperreflexia, sweating, shivering and tremor
   - possibly leading to seizures and coma
2. Ergot alkaloids

Question 13

How does propanalol (and other beta-blockers) contibute to migraine prophylaxis?
Side effects?

Answer 13

• regulates blood flow
• reduces BP
• most commonly used
• fatigue, dizziness, reduced libido, dream effects, asthma exacerbation

Question 14

What is amitryptiline (and other TCAs) used for with migraines?
Side effects?

Answer 14

• prophylaxis
• much lower than depression doses though
• dry mouth and eyes, drowsiness

Question 15

Gabapentin and Candesartan are both used for migraine prophylaxis. How do they do this?

Answer 15

Gabapentin

• anticonvulsant
• possibly modulates GABA receptors

Candesartan

• ARB
• reduces BP

Question 16

What dietary supplements can be used for migraine prophylaxis?

Answer 16

• riboflavin
• coenzyme Q10
• magnesium citrate