Headache Flashcards
Tx for acute migraine headache, mild-mod intensity
TRIPTANS - EXPENSIVE!
ERGOT ALKALOIDS! ADRS!
Triptan MOA
Serotonin Receptor Agonists
Mediates vasoconstriction
Receptors found on
- Cranial arteries
- Basilar artery
- Dura mater vasculature
Triptan CI
Basilar migraine
Vascular problems (cardiac, cerebra, peripheral)
Uncontrolled HTN
Liver disease
Triptan Common ADRs
- Parasthesias
- Fatigue
- Flushing
- Chest tightness
- Sweating
Triptan Serious ADRs
HEART STUFF
- Coronary artery vasospasm
- Transient myocardial ischemia
- MI
- Ventricular tachycardia
- HTN
Triptan drug interactions
Ergots alkaloids CI with all triptans
SSRI’s
Drugs that cause long Q-T interval
Amlotriptan - sulfa!
Which triptan can’t be used in patients w a sulfa allergy?
Amlotriptan
TRIPTANS
1st line tx for acute headache
Almotriptan (Elmo!) sulfa allergy
Eletriptan (Dumbo!)
Naratriptan (Nala from Lion King!)
Rizatriptan (Oral disintegrating tablets)
Frovatriptan (Frodo!)
Sumatriptan (Suma wrestler!) Sub q, nasal spray
Zolmitriptan (Nasal spray, disintegrating tablets)
ERGOT ALKALOIDS
1st line tx for acute headache
Ergotamines:
- Ergomar (ergotamine tartrate)
- Cafogar (ergotamine + caffeine)
- DHE (dihydroergotamine)
Ergotamine indications / CI
Indications
- abort or prevent vascular headache
CI
- Renal failure
- Hepatic failure
- Vascular disease
- Uncontrolled HTN
- Pregnancy / breastfeeding
- Basilar or hemiplegic migraine*
Ergotamine MOA
Nonselective 5-HT receptor agonist
(as opposed to Triptan which is selective)
Direct vasoconstriction of peripheral smooth muscle and cranial blood vessels
**may have anti-inflammatory effects*
How is DHE different from other ergotamines?
Dihydroergotamine
Stronger vasoconstrictor than non-hydrogenated ergot amines »_space;> binds 5HT and NE / DA receptors
Available as injection or nasal spray
Works for cluster headaches
Ergotamine ADRs
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Weakness
- Fatigue
- Chest tightness
Ergotamine Warnings
Ergotism (St Anthony’s fire)
- HA, vomitting, diarrhea, gangrene
Life-threatening ischemia
- If administered along w strong CYP3A4 inhibitors
Ergotamine drug interactions
Serotonin drugs
P450 / 3A4 inhibitors
Vasoconstrictors
2nd line drug for migraine tx
Butorphenol
Nasal spray, injection
Butorphenol MOA
Partial opioid agonist, analgesic
addictive
Butorphenol ADRs
Nausea
Vomitting
sleepiness OR insomnia
Dizziness
Respiratory depression
3rd line drugs for migraine tx
Fiorinal
(Butalbitol, aspirin, caffeine)
Fioricet
(butalbitol, acetomenaphen, caffeine)
both have preparations w codeine
Fiorinal / Fioricet indications
Tension headache, migraine
Fiorinal / Fioricet ADRs
Nausea
Drowsy
Dizzy
Abdominal pain
watch for overuse - more than 2x weekly is too much
What to do when prescription / self administered therapy fails for migraine:
IV !
DHE
Lorazepam
Valproic acid (Depacon)
IM Toradol (strong NSAID)
Parenteral narcotics
Acute migraine in ED, 1st line tx
IV Compazine or Reglan
Sub Q Sumatriptan
Acute migraine in ED, 2nd line tx
IV Acetomenaphine, Valproate
