4 - Migraine Drugs Flashcards
What are serotonin (5-HT) receptors?
Important for pain modulation - especially chronic pain
What modulates pain/nociception in descending pathways?
Serotonin and serotonergic neurons
What is known to be a cause of migraines?
5-HT dysregulation
How do ergot derivatives work against migraines?
- Vasoconstricts peripheral and cranial vessels
- Inhibits depolarization of dural blood vessel-associated nociceptors
- Possibly blocks neurogenic inflammation
- Taken at onset of migraine attack
Why is caffeine added to ergot derivatives?
Caffeine speeds gastric absorption getting medication into system more rapidly
What are the ergot derivative drugs?
- ergotamine (Ergomar)
- ergotamine and caffeine (Cafergot, Migergot)
- dihydroergotamine (Migranal) - longer half life for chronic migraine, protracted, unresponsive migraine
What anti-migraine drugs cause vasoconstriction and reduces neurogenic inflammation, and also provides relief from nausea “antiemetic”?
Triptans
What was the first triptan?
sumatriptan
What are the other triptans to treat migraines?
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
What are some characteristics of isometheptene (Midrin)?
- Contains acetaminophen and dichloralphenazone
- Migraines and tension headaches
What are some characteristics of antiemetics?
- Phenothiazine derivatives (antipsychotics)
- May cause extrapyramidal effects
What are the antiemetics?
- prochlororperazine (Compro)
- metoclopramide (Reglan)
- promethazine (Phenergan)
What are the different drugs for migraine prophylaxis?
- Tricyclic antidepressants
- SSRI’s
- Selective 5-HT and NE reuptake inhibitor
- Beta Blockers
- Anti-seizure medications
- Calcium channel blockers
- NSAIDS - indomethacin (Indocin)
- **Corticosteroids **
What drug treats intractable migraine that has not responded to other interventions?
Corticosteroids
What are the mechanisms of action for corticosteroids against migraines?
- Modulation of GABA receptors
- Suppresses neurogenic inflammation
- Block neurogenic extravasation mediated by release of neuropeptides like substance P
- Block effects of high-voltage activated Ca++ currents by blocking Ca++ channels
