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Brain And Behavior Exam 4 > Lec 66 Drugs to treat headaches > Flashcards

Lec 66 Drugs to treat headaches Flashcards

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1
Q

What are classic prodrome symptoms of migraine?

A

mood change, fatigue, muscle tension, yawning, cognitive dysfunction

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2
Q

What is mech of neurogenic inflammation

A

trigeminal nerve activation –> release of CGRP/substance P/neurokinin A causes vasodilation, mast cell degranulation –> neurogenic inflammation within meninges –> pain

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3
Q

What is use of NSAIDs in migraine treatment?

A 
non-specific acute treatment
efficacy comparable to oral triptans
dosing limited due to concern for renal toxicity
non-sedating
no increase in nausea
safe in presence of vascular disease
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4
Q

What is use of neuroleptics in migraine treatment?

A

D2 antagonist to treat headache pain and migraine-associated nausea

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5
Q

Why shouldnt you treat migraine with opioids?

A

poor efficacy/paradoxical increased pain sensitivity b/c:

  • pro inflammatory [degranulate mast cell], vasodilator, activate opioid receptors
  • drug seeking behavior
  • increase N/V
  • poor efficacy
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6
Q

What is role of dopamine in migraine?

A
  • prodomal symptoms are due to DA activation
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7
Q

What is effect of DA antagonists in migraine? side effects?

A
  • antiemetic
  • sedative

side effects = sedation and orthostatic hypotension

ex. metoclopramide

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8
Q

What are some names of D2 antagonists that are used to treat migraines?

A

given IV usually

  • cholopromazine
  • prochlorperazine
  • droperidol
  • metoclopramide
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9
Q

What are advantages/disadvantages of neuroleptics as migraine treatment?

A
  • effective IV, reduce N/V

side effects:
- sedation, prolonged QT, orthostatic HTN,
extrapyramidal effects [dyskinesia]

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10
Q

dihydroergotamine: use, mech, effects, other

A

use: specific acute treatment to stop migraine
mech: agonist to 5HT-1D receptor
effects: vasoconstriction, nausea
contraindications: vascular disease, HTN, renal/hepatic failure, pregnancy
other: less specific for 5HT receptor compared with triptans

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11
Q

How does giving 5HT effect migraine?

A

IV 5HT relieves migraine but intolerable side effects

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12
Q

triptans use, mech, effects, other

A

use:

mech: 5HT1B/D (and some 1G) receptor agonist

effects:

other

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13
Q

What are the 3 mechs of action triptans in improving migraine symptoms?

A
  • intracranial vessel vasoconstriction [5HT1B]
  • peripheral neuronal inhibition [5HT1D]
  • presynaptic dorsal horn stimulation [5HT1D] causes 2nd order brainstem neuronal inhibition
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14
Q

What are effects of triptan?

A
  • reduce all aspects of migraine disability
  • minimal or no sedation
  • intrinsic antiemetic properties
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15
Q

What is use of opioids in migraine treatment?

A

emergency/rescue treatment

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16
Q

What is clinical triad of serotonin syndrome?

A
  • mental status change
  • autonomic hyperactivity [HTN, fever, shivering, diarrhea]
  • neuromuscular abnormality [myoclonus, ataxia, hyperreflexia]
17
Q

When should you consider preventative migraine treatment?

A
  • headache freq > 6 per month
  • headahce disability too often
  • acute meds inneffective or contraindicated
  • prolonged migraine aura or profound disability
18
Q

What is mech of migraine prevention?

A
  • raise threshold for migraine activation [inhibit CSD, sensitization, neurogenic inflammation]
  • stabilize more reactive nervous system
19
Q

What is use of antiepileptic drugs as migraine prophylaxis? which drugs?

A

valproate and topiramate

20
Q

valproate: use, mech, effects, other

A

use: migraine prophylaxis or epilepsy
mech: block Na channels
effects: nausea, weight gain, tremor, alopecia, encephalopathy, hepatitis, pancreatitis
other: contraindicated in pregnancy

21
Q

topiramate: use, mech, effects, other

A

Use: migraine prophylaxis or epilepsy

mech: block Na/Ca, increase GABA-A

effects:

other:

22
Q

What should you use to treat pt with bipolar disorder and migraine?

A

valproate

23
Q

What is effect of propanolol in migraine?

A

beta blocker = prophylaxis for migraine

24
Q

How is efficacy of antidepressants as migraine treatment affected by presence/absence of depression?

A

not affected!

25
Q

What is role of ca-channel antagonists in migraine?

A

exact mech uncertain
verapmil = L-type Ca channel blocker = most commonly used
may be good for migraine with prolonged aura or vestibular migraine

26
Q

Onabotulinum toxin A: use, mech

A

Use: chronic migraine prophylaxis

mech: Inhibits release Ach at NMJ, blocks peripheral sensitization

Brain And Behavior Exam 4 (24 decks)

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