Drug tx for migraines Flashcards
Sumatriptan class and MOA
Triptan,selective agonists for sertonin 5-HT1b and 5-HT1d receptors, vasoconstriction of cerebral vessels, presynaptic receptors inhibit release of pro-inflammatory neuropeptides (CGRP, substance P, etc.) from trigeminal nerve endings, oral/nasal/subQ, 1/2 life of 2 hours
Dihydroergotamine
ergot alkaloids, moa has multiple targets: alpha adrenoceptors/5-HT/D2 receptors, partial agonist causing vasoconstriction of cerebral vessels, nasal/parenteral/SC/IM/IV/transdermal, longer 1/2 life than sumatriptan 12-24 hours
Erenumab
CGRP (calcitonin gene related protein) antagonist, CGRP involved in trigeminal nerve pain transmission and is potent dilator of cerebral and dural arterioles, SC injection
Oxygen
15 minutes 12L/min normally subsides migraine and cluster headache
Mild headache tx
acetaminophen, NSAIDs
1st Line headache tx
NSAIDs, triptans, combination analgesic
2nd line headache tx
dihydroergotamine nasal, parenteral NSAID
Refractory Migraine tx
IV dexamethasone, DHE injection, Valproate IV, Mg Sulfate, Opiods
Sumatriptan adverse effects/contraindications
numerous CNS effects/flushing/chest discomfort/unpleasant taste, Contraindicated in CAD, preganancy category C, do not use more than 2 days per week or 10 a month, drug-drug reactions with vasoconstrictor agents
Dihydroergotamine adverse effects/contraindications
nausea/vomiting (d2 receptors), cardiovascular events/dizziness/somnolence/rhinitis with nasal spray, reacts with CYP3A4 inhibitors (some macrolides) which increase risk of vasospasms, contraindicated with cardiovascular disease pts and is preg category X, do not use more than 2 days per week
Prophylactic drugs and classes for migraine and cluster headaches
AAAC; Antihypertensives (propranolol, verapamil), Antidepressants (amitriptyline, Venlafaxine), Anti-epileptic drugs (valproic acid, topiramate), CGRP inhibitors (Erenumab)
