How is the trigeminal nerve involved in migraines?

Its afferents from the cranial arteries seem to be unusually activated; this results in release of neurokinin A, substance P, and GCRP onto the meningeal arteries – leading to vasodilation and protein extravasation

What is the first-line treatment for migraines?

Triptans – specifically sumotriptan

What is the mechanism of sumotriptan?

It is an agonist of the 5HT-1d and 5HT-1b receptors (in the meningeal vessels, trigeminal nerve, and brainstem – the tri-gem hat, the meningeal headband, and the brainstem hair)

What effect does stimulating the 5HT-1d and 5HT-1b receptors have?

It causes vasoconstriction of the meningeal arteries and causes less vasodilatory cytokines to be released from the trigeminal nerve.

In what patients are triptans contraindicated?

Those with angina; triptans work by causing vasoconstriction. Vasoconstricting the coronary arteries can worsen angina. (Guy falling on the artisan working the angina anvil.)

What other condition can be treated with triptans?

Cluster headaches – think of the cluster of lanterns behind the wrestlers.

What treatments are used for long-term migraine prophylaxis?

Calcium blockers (the soft-serve – which contains lots of calcium – with blocked channels next to the long-time fans) Beta-blockers Valproic acid (an antiepileptic; think of the festiVAL of PRO wrestling) Topiramate (another anti-epileptic; think of the child with the toupee) TCAs (child on tricycle)

Sketchy Pharm: Triptans and Migraine Flashcards by Billy Tran

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Sketchy Pharm: Triptans and Migraine Flashcards

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