406 E2 - Migraines

Question 1

migraines definition

Answer 1

episodic neurological disorder that is characterized by a headache that lasts anywhere from 4-72 hours

Question 2

features needed to diagnose a migraine

Answer 2

needs at least 2 of these
-unilateral head pain
-throbbing pain
-worsens w/ activity
-moderate/severe pain
+ needs 1 of these
-N/v
-photophobia
-phonophobia

Question 3

classifications or migraines

Answer 3

-auro present
-aura not present
-chronic

Question 4

aura present means

Answer 4

presence of visual, sensory or motor symptoms

Question 5

what is the most common type of migraine

Answer 5

aura not present

Question 6

chronic migraines classification

Answer 6

15 days/month for 3 months

Question 7

risk factors for migraines

Answer 7

-family history
-estrogen & progesterone (women higher risk)
-genetic and environmental factors

Question 8

triggers for migraines

Answer 8

fatigue, sleep disturbance (too much or too little), missed meals, overexertion, weather change, stress, hormonal changes, alcohol, strong smells and bright lights

Question 9

when does risk of headaches decrease in women

Answer 9

during pregnancy

Question 10

pathophysiology of a migraines

Answer 10

not well understood
-change in neurotransmitter levels in CNS (increase of neuronal depolarization resulting in hyper activity)
-blood vessel tone (vasodilation)

Question 11

clinical phases: premonitory phase

Answer 11

1/3 of people have fatigue, irritability, loss of concentration, stiff neck, food cravings

Question 12

clinical phases: migraine aura

Answer 12

up to 1/3 have aura symptoms lasting up to 1hr

Question 13

clinical phases: headache phase

Answer 13

-throbbing pain
-fatigue, nausea, vomiting, dizziness, hypersensitivity to touch on head
-last 4 to 72 hrs

Question 14

clinical phases: recovery phase

Answer 14

-irritability, fatigue, or depression

Question 15

abortive (symptomatic) therapy for

Answer 15

-aspirin like drugs (ASA, acetaminophen, NSAIDs), for mild cases
if not affective can add
-serotonin receptor agonists (triptans)
-calcitonin gene related peptide (CGRP) if you cannot tolerate triptans
-zofran

Question 16

what is the most effective combination of abortive migraine meds for moderate to severe attacks w/o severe nausea and vomiting

Answer 16

oral migraine specific agents
triptans -> combo of sumatriptan & naproxen

Question 17

what class is sumatriptan

Answer 17

serotonin 1B/1D receptor agonists

Question 18

sumatriptan MOA

Answer 18

-constrict intracranial blood vessels
-suppress release of inflammatory neuropeptides
-block brain pathways for pain

Question 19

sumatriptan routes

Answer 19

subq, PO, intranasal

Question 20

sumatriptan SE

Answer 20

-injection site reaction
-chest pressure
-flushing
-weakness
-headache
-bad taste

Question 21

sumatriptan nursing considerations

Answer 21

avoid w/ ischemic stroke or heart disease and angina

Question 22

what class is rimegepant

Answer 22

CGRP Antagonists

Question 23

rimegepant MOA

Answer 23

mediates pain transmission

Question 24

rimegepant route

Answer 24

PO

Question 25

rimegepant SE

Answer 25

GI upset

Question 26

rimegepant considerations

Answer 26

-CYP substrate
-used to treat acute migraine where triptans aren’t effective or contraindicated

Question 27

when is preventive therapy recommended for migraines

Answer 27

when someone suffer more than 4 migraines per month or migraines last more than 12 hrs

Question 28

preventive therapy for migraines

Answer 28

-beta blockers
-tricyclic antidepressants
-antiepileptic drugs (divalproex, topiramate)
-estrogen

Question 29

preventative therapy goals

Answer 29

-reduce attack frequency, severity and duration
-improve responsiveness to treatment of acute attacks
-improve function and reduce disability
-prevent progression or transformation of episodic migraine to chronic migraine