Anti-migrane Flashcards
Define migrane
common type of headache of unknown cause
Duration of the migraine attack
several hours or days.
What can the frequency of migraines be?
1-8 episodes per month
What are the known triggers of migraines? (6)
- alcohol
- chocolate
- cheese
- fasting
- menstruation
- oral contraceptives
Migrane patients: (3)
- Family history 2/3 of the patients.
- Age of onset: late teens or young adults.
- More common in women.
Migrane characteristics? (5)
- Throbbing pain.
- Hemicraneal.
- Moderate to severe intensity.
- Usually accompanied by photophobia, nausea and vomiting.
- Often preceded by aura: odors, visual disturbance-flashes
Frequency of migraine with aura? what else is it called?
15%
classic migraine
What is an aura?
feelings and symptoms you notice shortly before the
headache begins
Frequency of migraine without aura? what else is it called?
75%
common migrane
What is the common migrane?
without aura
What is the classic migrane?
with aura
What is status migrainous? What happens?
- migraine lasts longer than 72 hours
- sometimes requires hospitalization
What molecules affect the aura for migranes?
- Serotonin (5-Hidroxitriptamina 5-HT)
- Dopamine
What drug classes can we use to treat migranes? (5)
- PARACETAMOL
- NSAIDS
- MINOR OPIATES 4.TRIPTANS
- ERGOTAMINE
What drugs do we use to start treating migraines? examples? (4)
- PARACETAMOL
- NSAIDS - naproxen/ibuprofen/ketorolac
- MINOR OPIATES
- anti-nausea - metoclopramide
When is metoclopramide used with migraines?
15 min before to prevent nausea and vomitting
What do you use if the first step in treatment of migraines doesn’t work?
serotoninergic agonists:
- TRIPTANS
- ERGOTAMINE
Triptans and ergotamines are what type of drug? what are they used for?
- anti-migrane
- serotoninergic agonists
What are the triptan drugs? (4)
- sumatriptan
- naratriptan
- zolmitriptan
- rizatriptan
What is the mechanism of action for sumatriptan?
-5-HT receptor agonist
What are the effects of sumatriptan?
- vasoconstriction:
- coronaries
- carotid
- extracranial
How effective is sumatriptan? (2)
- very effective if given in inital phases of migrane
- repeat 1-2 hours if not completely improved
How is sumatriptan administered? (3)
SC
Intranasal
oral
What are the problems with sumatriptan? (2)
- lack of response
- reoccurrence in 24hrs
sumatriptan contraindications? (4)
- coronary heart disease
- uncontrolled hypertension
- > 55yrs
- pregnancy
What effects does ergotamine have? (2)
-anti-migrane
-potent arterial vasoconstrictor (extracranial arteries)
-
What happens to blood vessels during a migraine? where? (2)
- vasodilation
- extracranial arteries
What is the dosing for ergotamine?
earlier it is administered, the lower the dose that is required
What is the daily maximum dose for ergotamine?
4-6mg
What is the dosage for ergotamine? When is it repeated?
- 1mg oral or rectal
- repeated after 30 mins if no improvement
What is the side effect of ergotamine?
-higher doses, risk of ischemia
When do you use preventative measures for migraines? (5)
- Chronic daily headache
- > 2-3 episodes/month
- Bad response or lack of tolerance to symptomatic treatment
- Complicated migraine
- Disabling pain: socio-occupational impact.
What class of drugs are used as preventative treatment for migraines? (6)
- TRICYCLIC ANTIDEPRESSANTS: Amitriptyline + benzodiazepines
- BETA BLOCKERS: Propranolol
- METHYSERGIDE (ONLY IF FAILURE OF THE ABOVE):
- CYPROHEPTADINE: antiserotoninergic, use in children
- CALCIUM ANTAGONISTS: flunarizine, nimodipine, nicardipine, verapamil
- ANTIEPILEPTICS: valproic acid, topiramate
What beta blocker do we use as preventative migraine treatment?
propranolol
When do we use methysergide as a preventative measure against migraines?
only if tricyclic antidepressants and beta blockers do not work
What effect does methysergide have? (2)
- antiserotoninergic
- vasoconstrictor
What effect does CYPROHEPTADINE have?
antiserotoninergic
When is CYPROHEPTADINE used in migraines? (2)
- preventing migraines
- children
Which tricyclic antidepressants do we use as a preventative measure against migraines? with what? (2)
Amitriptyline + benzodiazepines