French Headaches Flashcards
The drug of choice for treatment of moderate to severe migraine is:
A. Acetaminophen
B. A “triptan”
C. An ergot
D. Onabotulinum toxin
B. A “triptan”
Compared to oral sumatriptan, the subcutaneous formulations:
A. Relieve pain faster
B. Are more effective in relieving pain
C. Cause more adverse effects
D. All of the above
D. All of the above
Which of the following would NOT be a consideration for starting pharmacotherapy for migraine prevention?
A. Headaches are severe
B. Headaches that don’t respond to opioid therapy
C. Patient cannot tolerate NSAIDs
D. Patient has a contraindication to acute vasoconstrictor therapy
E. Headaches are disabling
B. Headaches that don’t respond to opioid therapy
A patient presents to urgent care with a chief complaint of a unilateral, pulsatile headache associated with nausea. The physician prescribes a 5HT1B/1D agonist as an acute abortive agent. The use of this agent would be contraindicated or require cautious use in which of the following conditions or situations?
A. Ischemic heart disease
B. Moderate to severe migraines
C. Patients who are also taking NSAIDs for osteoarthritis
D. Patients who are also taking an alpha-blocker for benign prostatic hyperplasia (BPH)
A. Ischemic heart disease
What is the basic pathophysiology of a migraine?
Trigeminal nerve dysfxn leads to prostaglandin release causing neuroinflammation and resulting in vasodilation and moderate to severe pain
What is the target of NSAID analgesics for mod to severe pain?
inhibit COX-2 (cox 2 causes inflammation and pain)
What is the target of triptans-ergot alkaloids?
5HT 1b-1D agonists
**good in acute treatment
What neurotransmitter plays a role in migraine and is a primary target for pharmacotherapy?
serotonin
Which of the following is a reasonable choice for initial treatment of a mild migraine attack without nausea or vomiting in a 28- year old nonpregnant women?
acetaminophen
What medication is used in the termination of ACUTE migraine?
triptans (5HT 1B/D agonists)
–basically vasoconstricts and inhibits neuropeptide release
CGRP receptor antagonists
Ergot Alkaloids
NSAID
What is the onset of action of short-acting triptans?
30-60 minutes
What are some serious side effects of triptans?
coronary vasospasm, additive vasoconstriction and serotonin syndrome
What drugs are contraindicated in vascular disease for migraine?
Triptans
What drug is similar to triptans but is NOT contraindicated in patients with vascular disease?
Lasmiditan
-similar to triptans but selective agonist on the 5HT1F receptors
What drugs are new on the market and less effective than triptans but an option if triptans don’t work?
Urbegepant & Rimegepant
There are small molecule antagonists that bind to calcitonin gene receptor peptide inhibiting vasodilation
