Antimigraine medication Flashcards
if a pt has a migraine and wants to take paracetamol or aspirin, what would you recommend? why?
Recommend soluble or dispersible paracetamol or aspirin
This is because peristalsis tends to be impaired (muscle contraction) when one has a migraine so taking a normal tablet with water wont be as effective as soluble/dispersible
Can an NSAID be used for migraine?
Yes, specifically, tolfenamic acid (licensed for migraine)
What other medication is used for migraines?
TRIPTANs - sumatriptan, rizatriptan (5HT-1 agonists)
What’s the main problem with the triptans?
a pt can get a medical overuse headache - pt keeps taking medicine and that spurs headache within itself.
If a pt is feeling sick from a migraine, what would you recommend?
Metoclopramide
if pt is vomiting, what would you recommend?
a rectal formulation
in which pts are the triptans contraindicated in?
pts who have had a myocardial infarction or those who iscahemic heart disease
What are the S/E of triptans? Why have these S/E occured?
tightness in the chest and throat - stop taking.
could be due to coronary vascular constriction or anaphylaxis
What else can be used for migraines?
ergot alkaloids - they are limited in their use and should be avoided - have lots of S/E - only used no more than twice a month to avoid ..
What triggers migraines?
could be stress, lifestyle (lack of sleep), alcohol, oral contraceptives
Which factors must a patient have if they should be considered for prophylaxis treatment? (4)
- at least 2 attacks per month
- increased frequency of headaches
- significant disability despite suitable treatment
- not taking suitable tx.
What is prophylaxis treatment for patients who suffer from migraines?
- BB
- TCA
- Na valproate
- Gabapentin
- Topiramate
- Pizotifen
- Botox (reserved for patients who have more than 15 headaches a month and that are associated with migraine)
What is a cluster headache?
attacks of headache around the eye
pt can get nasal stuffiness, and unilateral photophobia
What tx is given for patients who have a cluster headache?
sumatriptan (SC injection or nasal spray) and Oxygen
When is prophylaxis considered for patients who have cluster headaches?
attacks that last for more than 3 weeks or their attacks are frequent and its not treated effectively.
