Exam 2 - Migraines Flashcards
diagnosis of migraines
two of these must occur:
- unilateral head pain
- throbbing pain
- worsens with activity
- moderate/severe pain
one of these must occur:
- n/v
- photophobia
- phonophobia
classifications of migraines
- aura present
- aura not present
- chronic: 15 days/month for 3 months
risk factors for migraines
- family history
- estrogen and progesterone
- genetic and environmental factors
triggers for migraines
- fatigue
- sleep disturbance
- missed meals
- overexertion
- weather change
- stress
- hormonal changes
- alcohol
- bright lights or strong smells
pathophysiology of migraines
- change in neurotransmitter levels in CNS
- blood vessel tone
clinical phases
- premonitory phase
- migraine aura
- headache phase
- recovery phase
premonitory phase
1/3 have fatigue, irritability, loss of concentration, stiff neck, food cravings
migraine aura
up to 1/3 have aura symptoms lasting up to 1 hour
headache phase
- throbbing pain
- fatigue, nausea, vomiting, dizziness, hypersensitivity to touch on head
- lasts 4 to 72 hours
recovery phase
irritability, fatigue, or depression
abortive (symptomatic) therapy
- aspirin like drugs: ASA, acetaminophen, NSAIDs
- serotonin 1B/1D receptor agonists: sumatriptan
- calcitonin gene-related peptide antagonist
serotonin 1B/1D receptor agonists
sumatriptan
sumatriptan MOA
- constrict intracranial blood vessels
- suppress release of inflammatory neuropeptides
- block brain pathways for pain
sumatriptan routes
- sub q
- PO
- intranasal
sumatriptan side effects
- injection site reaction (SQ)
- chest pressure
- flushing
- weakness
- headache
- bad taste (nasal)
sumatriptan considerations
avoid with ischemic stroke, heart disease, and angina
CGRP antagonist
rimegepant
rimegepant MOA
mediates pain transmission
rimegepant route
PO
rimegepant side effects
GI upset
rimegepant considerations
CYP substrate
preventive therapy
- beta blockers: propranolol
- tricyclic antidepressants
- anti epileptic drugs: divalproex and topiramate
- estrogens: menstrual migraine
preventative therapy goals
- reduce attack frequency, severity, and duration
- improve responsiveness to treatment of acute attacks
- improve function and reduce disability
- prevent progression or transformation of episodic migraine to chronic migraine
