Chapter 59: Migraine Flashcards
When should patients seek immediate medical attention for a migraine
HA accompanied by fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, chest pain, SOB or aphasia (trouble speaking)
Which neurotransmitter may play a role in migraines
serotonin
changes in trigeminal nerve or imbalances of neurotransmitters
Treatment for menstrual-associated migraine (MAM)
monophasic oral contraceptives or estradiol patch or creams
Can use POPs for migraine with aura
Women who have migraine with aura are at higher risk for ____ and should avoid ____
stroke
estrogen-containing contraceptives (can use POPs)
Fluctuation in ___ can cause menstrual-associated migraine (MAM)
estrogen
Migraine diagnosis
At least 5 attacks fulfilling the following criteria:
- HA last 4-72 hrs
- Have ≥ 2 of the following: unilateral location, pulsating, mod-severe pain and aggravated by routine physical activity
- One of the following occurs during the HA: nausea &/or vomiting, photophobia, and phonophobia
Which natural products can be used for migraines
Caffeine, Butterbur, feverfew, magnesium, riboflavin
Which medication does Advil Migraine contain
Ibuprofen
Which medications does Excedrin Migraine contain
aspirin, acetaminophen, and caffeine
Naproxen brand name
Aleve
Rx options for acute treatment of migraine
serotonin receptor agonists (triptans)
Which pain meds are not recommended due to abuse/dependence issues
Opioids, butalbital-containing products, tramadol and tapentadol
Triptan MOA
5-HT1 receptor agonists and cause vasoconstriction of cranial blood vessels
First-line for acute migraine treatment
Triptans
When are triptans most effective
When used at first sign of a migraine
Rizatriptan brand name
Maxalt-MLT
Zolmitriptan brand name
Zomig ZMT
sumatriptan brand name
Imitrex
Sumatriptan oral dose can be repeated x1 after __ hrs
2
Sumatriptan SC dose can be repeated x1 after __ hrs
1
Zembrace SymTouch can be repeated how many times per day
4
Sumatriptan
Imitrex nasal spray can be used in one nostril and can repeat x1 after __ hrs
2
Onzetra Xsail powder should be used in
each nostril
Sumatriptan
Triptan CI
Cerebrovascular disease (stroke/TIA), uncontrolled HTN, ischemic heart disease, use within 24 hrs of another triptan
Triptan warnings
risk of increased BP, serotonin syndrome
Triptan SE
Paresthesia (tingling/numbness), triptan sensations (pressure or heaviness in the chest or pressure in the neck region)
Triptan nasal sprays contain how many doses
1 (do not prime)
How must Treximet (sumatriptan + naproxen) be dispensed
in original container
Maxalt-MLT, Zomig ZMT ODT should not be used in patients with
phenylketonuria
Which triptans are approved for children 12+
Almotriptan tabs, zolmitriptan nasal spray and Treximet (sumatriptan and naproxen)