HA Mangement (KEY POINTS) Flashcards
What is believed to be the pathogenesis of migraines?
Related to complex dysfunctions in neuronal & broad sensory processing
What is the pathophys of migraines?
Vasodilation of intracranial blood vessels –> activation of trigeminal nerves –> release of neuropeptides –> inflammation
What can continued afferent input result in?
Sensitization of central & sensory neurons –> hyperalgesic state that responds to previously innocuous stimuli & maintains HA
Central pain transmission may activate…
other brain stem nuclei –> N/V, photophobia, phonophobia
What are OTC acute migraine therapies?
Analgesics
NSAIDs
What is the MOA of ergot?
Nonselective 5-HT1 receptor agonists
Constricts intracranial blood vessels & inhibits inflammation
Central inhibition of trigeminovascular pathway
What is the MOA of triptans?
Selective agnoists of 5-HT1B & 5HT1D receptors
Inhibits peptide release
Inhibits transmission to thalamus
What should be combined w/ sumatriptan?
Naproxen, 85/500mg
What dose of rizatriptan should be used in pts receiving propranolol?
5mg (15mg/day max)
What type of drug tx should you consider prior to giving ergotamine tartrate PO or rectal?
Antiemetic
How do you use dihydroergotamine nasal spray?
Prime sprayer 4 times before using
Do not tilt head back or inhale through nose while spraying
Discard after 8hrs
What is metoclopramide & prochlorperazine used for?
Acute relief in office or ED
What is sumatriptan used for?
Migraine & cluster HA
What are ADEs of sumatriptan?
Dizziness
Coronary vasospasm
CP
Paresthesias
How do you treat serotonin syndrome?
Benzos –> sedation, paralysis, intubation, & ventilation
