Lecture 10 - Migraine (also see ICM deck)

Question 1

Migraine:

aura (24 hours before headache) symptoms include ___uria, _____ (GI prob), ____ (CN prob), changes in mood/appetite

Answer 1

poly, diarrhea, hyperacusis;

Question 2

which migraine subtype has an aura, classic or common? which is more common overall? which can be aggravated by routine physical activity?

Answer 2

classic, common, common

Question 3

migraine-

what kind of receptors are highly expressed in the trigeminovascular system?

Answer 3

serotonin

ie 5-HT1B, 1D, 1F

Question 4

migraine path:
initially, cortical spreading ____ elevates extracellular ___, ____ NO, and amino acids, which activate TG nociceptors (afferents)

Answer 4

deprression;

K+, H+

Question 5

acute migraine treatment:

combintations of NSAIDs and _____ or ____ (a barbituate) are effective

Answer 5

caffeine, butalbital

Question 6

_____ is a kappa-opioid receptor agonist and u-opioid receptor _____. used for severe migraines. method of administration?

Answer 6

butorphanol;
partial agonist;
nasal spray

Question 7

what anti-emetic is used as an adjunct for migraines? method of action?

Answer 7

metroclpramide;

D2 antagonist

Question 8

example of an ergot alkaloid that treats acute migraine (found on rye apparently)

Answer 8

dihydroergotamine

also ergonovine, ergotamine

Question 9

ergot alkaloids are ____ and ___ receptor agonists.

Answer 9

5HT (Several subtypes);

alpha 1;

Question 10

ergot alkloid effects:
prolonged vaso____ which may result in _____.
GI probs;
uterine _____

Answer 10

spasm, gangrene (and amputation -__-);
stimulant

drug drug interactions with nitrates, beta-blockers, protease inhibitors, macrolides

Question 11

all triptans:

mechanism of action =

Answer 11

5-HT 1B/1D/1F agonists

Question 12

which has a higher incidence of headache recurrence, sumatriptans or ergot alkaloids?

Answer 12

suprisingly sumatriptan

Question 13

triptans:
sumatriptan has a relatively ____ half life.
naratriptan has a ____ onset, ____ duration of action = ____ Recurrence of headache

Answer 13

short (2 hours);
slow, prolonged;
decreased

Question 14

_____ is a triptan with a tricyclic structure. half life of 26 hours but 2-4 hour onset

Answer 14

frovatriptan

Question 15

triptan side effects:

strongly contraindicated in patients with _____ or _____ due to _____

Answer 15

CAD, prinzmetal angina; coronary vasospasm

Question 16

triptan side effects:
_____ (Nerve effect);
____ syndrome in combination with other _____ _____;
dizziness, fatigue, malaise

Answer 16

parasthesias;

serotonin, 5-HT agonists;

Question 17

_____ ____ = headache for > 72 hours with or without treatment

Answer 17

status migrainosus (refractory headache)

Question 18

_____ can be used for migraine prophylaxis. it inhibits NT release

Answer 18

botox

Question 19

botox:

cleaves ____ = decreased release of _________ = muscle relaxation/weakness

Answer 19

SNAP25 (a snare protein), Ach

Question 20

CGRP:
released from _____;
potentiates _____;
in development, are drugs that effect this how?

Answer 20

trigeminal nerve;
pain response;
receptor antagonists (ie telcagepant, but it was hepatotoxic)

Question 21

lasmiditan is a _____ agonist in development that inhibits release of inflammatory neuropeptides

Answer 21

5HT-1F