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
How do you treat neuroleptic malignant syndrome?
Diphenhydramine (parenteral)
How do you treat malignant hyperthermia?
Dantrolene
Which BB is MC used for prophylactic migraine therapy?
Propranolol
Which drugs are used for menstrual migraine prevention?
ibuprofen
Frovatriptan
Which form of triptans is most effective for cluster HAs?
sprays or injections
What is prophylactic therapy for cluster HAs?
Verapamil (1st line)
Lithium
Corticosteroids
