50 - migraines Flashcards
migraine types
migraine without aura (common)
- at least 5 attacks
- headache lasting 4-72 houes
- ___ location , pulsating, aggrevation by routine activity
- N?V , photophobia, phonophobia
unilateral
migraine types
migraine with aura (classic)
- at least __ attacks
- at least one fully reversible aura
- no aura lasting more the ___ min
- headache follows aura within ___ min
- aura symptoms: visual, sensory, speech, motor, brainstem, retinal
2
60
60
phases
phase 1: ___
- hours/days before headache
- may experence euphoria, depression, irritability, food craaving
phase 2: ___
- visual, sensory, vrebal, motor
- before or during migraine
- lasts less than 60 min
- photopsia (flash of light)or scotoma (blind spot), numbness
phase 3: migraine
- dull ache that intensifies
- ___ and throbing
- photo/phonophobia
phase 4: ___
- may last several days after headache has ended
- tiredness, head pain, GI distress, mood changes, weakness, cognition
prodrome
aura
unilateral
postdromal
migraien triggers
medication overuse
- rebound headaches from oveuse of ___ , ___ , or ___
OC, hydralazine, nitroglycerin, nifedipine, cocaine
chocolate, oranges, tomatoes, cheese, ear, alcohol, caffeine, aspatame
weather/altitude, perfume, smoke, noise, lights
too much or too little sleep, skipping meals, stress
ergot, triptans, analgesics
abortive vs preventative
abortive
- acute
- education to avoid medication overuse
- mild/moderate: ___ and APAP
- moderate/severe: ___ / ___
- ___ expensive than prevention
preventive
- ___ or more attacks/month with disability at least ___ days month
- failure of ___ treatment
- use of abortive meds more than teice per weak
NSAIDs
triptans/ergots
more
4, 3
acute
abortive treatment guidelines
first line: ___ and ___ , ergot, butorphenol, combo
second line: ___ , ergotamine, isometheptene compunds, codeine/APAP , tramadol/APAP, antiemetics
third line:
- failure of at least 2 triptans: __ , ___ , ___ , or device
- consider IV ___ , butalbital, IV dexamethasone, nasal lidocaine
NSAIDs, triptans
NSAIDs
ubrogepant, rimegepant, lasmiditan
valproate
prevention treatment guidelines
first line: monotherapy:
___ , ___ , ___ , ___ , timolol, ___ , botox
second line: monotherapy:
___ , venlafaxine, atenolol, nadolol
third line: monotherapy:
- lisinoprilm clonidine, guanfacine, carbamazepine, nebivolol, pindolol, cypreheptadine, candesartan, CGRP receptor antagonits
- valproate, topiramate, metoprolol, propranolol
- amitriptyline
triptans for abortive
selective ___ and ___ receptor agonists
CI:
- recent use of an ergot or other triptan
- (___ , ___ ) MAO-A inhibitor in last two weeks
- ISHD, stroke/TIA, atthythmias, PVD, uncrontrolled HTN,
- ischemic bowel disease
- hepatic impairment
warning/precautions
- MI
- chest/jaw/throat pain
- CVA, HTN, DI
- vasospasm
- overuse headache
- serotonin syndrome, headache
- sulfa allergy ( ___ )
- seizures (caution)
5-HT1B, 5-HT1D
frovatriptan, rizatriptan
almotriptan
triptans for abortive
SE
- oral - tingling, dizziness, drowsiness, fatigue, chest tightness/pressure, flushing
- theoretically use with SSRI/SNRI can cause serotonin sydrom, but rare and may not be caused by triptans
- avoid strong 3A4 inhibitors with ___
eletriptan
ergots for abortive
MOA: stimulate ___ receptor and decrease vascular tone with ___
CI:
- risk of CAD
- avoid administration with strong ___ inhibitors
warnings
- boxed warning for serious life threatening peripheral ischemia
- valvular fibrosis
- cerebrovascular events
SE
- fibrosis
- ergotism vasoconstrictive complications (ischemia, cyanosis, cold in extremeties, gangrene, numbness, weakness)
drug interactions
- CYP ___ inhibitors result in ergot toxicity
- alpha adrenergic, vasocontriction
- 3A4
- 3A4
calcitonin gene related peptide (CGRP) receptor antagonists abortive
pants
rimegepant, urbrogepant, zavegepant
MOA: blocks neurogenic inflammation and sensitivity to pain signaling, cause intracranial vaodilation, block inflammatory cytokines
CI
- strong ___ inhibitors
drug interactios
- moderate/strong ___ nducers and inhibitors, P-gp inhibitors
- 3A4
- 3A4
Lasmiditan abortive
5-HT 1F agonist
warnings/precautions
- overse headaches, sedation, dixxiness, driving impairment (avoid for at least 8 hours)
monitor
- LFTs, BP, HR
other abrotive
___ nasal spray as rescue
butorphanol
BBs - preventative
FDA approved
___ 80-240 mg/day
___ 100-200 mg/day
CI in asthma and raynauds syndrome
non-FDA approved
___ 25-150 mg/da y (mixed migrain/tension)
propranolol
metoprolol
amitriptyline
preventive CGRP antagonist
MOA: ___ - aooe blocks CGRP receptor sites on blood vessels
MOA: ___ - jimr , ___ - vfrm, ___ gnlm, atogeoant, rimegepant
SE
- atogepant: N, constipations, fatigue
- rimegepant: N, rash, dyspnea
erenumab
eptinezumab, fremanezumab, galcanezumab
