Headache disorders Flashcards
Drugs for migraine prevention
Valproate Fluoxetine, Amitriptyline, Desipramine, Phenelzine, Naproxen, Timolol, Propanolol, Verapamil, Methysergide, Gabapentin, Botulinum toxin A.
Valproate- Adverse effects
Sedation
Tremor
Weight gain
Fluoxetine - MoA
Selective serotonin reuptake inhibitors(SSRIs)
Fluoxetine - Adverse effects
Anxiety Insomnia Tremor Anorexia Sexual dysfunction
Tricylic antidepressants (TCA’s)
Amitriptyline and Desipramine
Amitriptyline and Desipramine - Adverse effects
Drowsiness
Tremor
Anticholinergic effects( dry mouth, blurred vision, urinary retention)
What is more effective of Amitriptyline and Desipramine?
Amitriptyline
Phenelzine - MoA
Monoamine oxidase inhibitors(MAOIs)
Can block serotonin degradation
Phenelzine - Adverse effects
Hypertensive crisis if they are taken with tyramine containing foods or with sympathomimetic amine drugs
Naproxen - MoA
Blocking thromboxane synthesis and platelet aggregation and thereby reducing the release of serotonin
Naproxen - Clinical use
Prevention AND treatment of migraine
Prevention of migraine headaches associated with menstruation cycle (arm 1 week before menstruation)
Timolol - MoA
Only B-blockers that lack intrinsic sympathomimetic activity are effective for prevention of migraine.
MOA for migraine is uncertain, but might block vasodilation mediated by B2 adrenoceptors. They may also reduce platelet aggregstion and decrease the level of serotonin from platelets.
Propanolol - MoA
MOA for migraine is uncertain, but might block vasodilation mediated by B2 adrenoceptors. They may also reduce platelet aggregstion and decrease the level of serotonin from platelets.
Verapamil - MoA
Preventing the vasocontrictive phase of migraine headaches
B-adrenoceptor antagonists used for prophylaxis of migraine
Timolol and Propranolol
Calcium channel blockers used for prophylaxis of migraine
Verapamil. But less effective than other classes of drugs.
Methysergide- MoA
Block 5-HT2 receptors and thereby prevent vasocontrictive phase of migraine from occuring
Methysergide- Adverse effect
Abdominal pain
Weight gain
Hallucinations
Life threatning:
Retroperitoneal, pleural and cardiac valve fibrosis
Gabapentin - MoA
Enhance GABA action in the tratment of seizure disorder, its migraine action is unknown.
Gabapentin - Clinical use
Seizure disorders
Postherpetic neuralgia
Moderatley effective in preventing occurence of migraine
Botulinum toxin A - MoA
Disrupts the neurotransmission of acetylcholine by preventing vesicle fusion with membrane of the presynaptic termina
Drugs for migraine termination
Ergot drugs:
Ergotamin
Dihydroergotamine
Triptan agents: Sumatriptan Naratriptan Rizatriptan Zolmitriptan Frovatriptan Almotriptan Eletriptan
Isometheptene
Opioids: Tramadol Butorphanol Acetaminophen with codeine Prochlorperazine
Ergot agents - MoA
Activating serotonin 5-HT1B/1D receptors
Activate receptors on pial and dural vessels leads to Vasocontriction
Activate presynaptic receptors to inhibit the release of peptides and other mediators from trigeminal neurons
Activate receptors in brain stem inhibit activation of trigeminal neurons responsible for migraine attacks.
Ergotamine and Dihydroergotamine - Clincal use
Migraine headache
Cluster headache
Parkinson disease
Hyperprolactinema
Ergotamine and Dihydroergotamine - Adverse effects
Nausea Vomitting Diarrhea Muscle cramps Cold skin Paresthesias Vertigo
Excessive dose can cause severe cerebral vaspcontriction, ischemia and reboud vasodilation and headache
Ergotamine and Dihydroergotamine - Special considerations and contraindications
Should not be used with B-adrenoceptor antagonists –> severe peripheral ischemia
Dihydroergotamine given with an antiemetic drug- metoclopramide when adm parenterally
Contraindicated in persons with coronary artery disease, or peripheral vascular disease
Triptan agents - Adverse effects
Chest tightness Weakness Somnolence Dizziness Abnormal tingling and burning sensation(paresthesias) Coronary vasospasm Increased blood pressure
Triptants - Contraindications
Coronary vasospasm:
Patient with history of angina pectoris, myocardial infarction or other coronary diseases.
Increased blood pressure:
patients with uncontrolled hypertension
Not be used with MAOIs, or within 24h og adm of an ergot alkaloid or methysergide.
Use of triptan with SSRI antidepressant agent increase the risk of triggering serotonin syndrome.
Which drugs would you prescribe to adolescent (12-17 y) with history of migraine attacks?
Almotriptan
Tramadol - MoA
Agonist at µ opioid receptors, and also inhibits serotonin and norepinephrine reuptake in CNS
Tramadol - Clinical use
Chronic pain syndromes
Butorphanol - MoA
Agonist at k opioid receptor and mixed agonist-antagonist at u opioid receptor.
Prochlorperazine - Classification and Clinical use
Antipsychotic
Aborting unremitting migraine headache when given IV.
What is the most used opioid for migraine?
Tramadol
