Drugs Used to Treat Migraine Headaches

Question 1

Discuss the role of serotonin and serotonergic receptors in pain modulation.

Answer 1

in platelets = causes vasoconstriction; in CNS = modulates nociception on a spinal level; stimulation- produced analgesia in midbrain; modulates pain in descending pathways

Question 2

Identify several classes of medications that can be used to manage migraines.

Answer 2

antidepressants, Hallucinogens, Anxiolytics, Antiemetics, Antimigraine agents, Atypical antipsychotics, appetite suppressants

Question 3

Describe the general mechanism of action of ergot derivatives for treatment of migraines

Answer 3

vasoconstrictors; inhibits depolarization of dural bv-associated nociceptors and possibly blocks neurogenic inflammation

Question 4

Describe the general mechanism of action of triptans for treatment of migraines

Answer 4

vasoconstrictors and reduces neurogenic inflammation; also provides relief from nausea= antiemetic

Question 5

Describe the general mechanism of action of isometheptene for treatment of migraines

Answer 5

vasoconstrictor, analgesic, and mild tranqulizing effect

Question 6

Describe the general mechanism of action of antiemetics for treatment of migraines

Answer 6

controls nausea and gastric irritation; antagonists of D2 receptors; may cause extrapyramidal effects; antiemetics are antipsychotics

Question 7

Identify several classes of medications that can be used for migraine prophylaxis.

Answer 7

tricyclic antidepressants, SSRIs, and Selective 5-HT and NE reuptake inhibitors, Beta Blockers, Antiseizure meds, Ca Channel Blockers, NSAIDs and Corticosteroids

Question 8

Name eight classes of drugs used prophylactically to treat migraines.

Answer 8

NSAIDS, tricyclic antidepressants, SSRIs, Selective 5-HT and NE reuptake inhibitors, beta blockers, antiseizure medications, calcium channel blockers, and corticosteroids

Question 9

Tricyclic antidepressants: mechanism of action (to treat migraines prophylactically)

Answer 9

down regulate 5-HT receptors that are associated with excitatory perivascular inflammation; also inhibit reuptake of both 5-HT and NE

Question 10

SSRIs: mechanism of action (to treat migraines prophylactically)

Answer 10

inhibits reuptake of 5-HT

Question 11

Selective 5-HT and NE reuptake inhibitors: mechanism of action (to treat migraines prophylactically)

Answer 11

venlafaxine (Effexor); also modulates anxiety

Question 12

Beta blockers: mechanism of action (to treat migraines prophylactically)

Answer 12

unknown mechanism: possibly vasoactivity

Question 13

Antiseizure medications: mechanism of action (to treat migraines prophylactically)

Answer 13

topiramate, valproic acid, gabapentin (inhibitory)

Question 14

Calcium channel blockers: mechanism of action (to treat migraines prophylactically)

Answer 14

verapamil (Calan) = interferes with release of Ca+ dependent release of substance P (a pain modulatory substance) and other neurotransmitters

Question 15

NSAIDS-indomethacin (Indocin): mechanism of action (to treat migraines prophylactically)

Answer 15

anti-inflammatory analgesic; alters cerebral blood flow without inducing vasospasm; able to modulate cerebral blood flow through nitric oxide pathways

Question 16

Corticosteroids: mechanism of action (to treat migraines prophylactically when intractable migraines have not responded to other interventions)

Answer 16

modulation of GABA receptors, suppresses neurogenic inflammation, block neurogenic extravasation mediated by release of neuropeptides like substance P, block effects of high-voltage activated Ca++ currents by blocking Ca++ channels