DLA14- Migraines (abridged)

Question 1

______ are indicated for mild to moderate migraine attacks

Answer 1

• acetaminophen

- NSAIDs

Question 2

______ are indicated for severe migraine attacks

Answer 2

• Triptans: sumatriptan

- Ergot alkaloids: ergotamine, dihydroergotamine

Question 3

Sumatriptan:

• (1) MOA
• usually administered with (2)
• usually administered in (3) formulation
• cautioned use in (4) patients

Answer 3

1- 5-HT1D agonist, 5-HT1B agonist

2- naproxen (better in combination)

3- SQ (although often given orally)

4- those with vascular disease, DM

Question 4

describe MOA of ergot alkaloids

Answer 4

-5-HT1D and 5-HT1B agonist

• D2 agonist
• α1/2 agonist

Question 5

list 1st line agents for migraine prevention

Answer 5

β-blockers: propanolol, timolol, metoprolol, nadolol, atenolol

Antiepileptics:

• Valproate, mixed inhibitor of V-gated Na and t-type Ca channels
• Topiramate, inhibits V-gated Na channels, GABA(a) agonist, Glutamate antagonist

Question 6

list the many 2nd/3rd line agents for migraine prevention

Answer 6

Antidepressants:

• TCAs: amitriptyline, nortriptyline, imipramine
• SNRIs: venlafaxine

CCBs (Ca channel blockers): verapamil
ACEIs, ARBs

Antiepileptics: gabapentin
Botox
NSAIDs