Lecture 8 - Migraine 2 Flashcards
Nerivio indiication
migraines in 12yrs or older
Relivion MG Indication
migraines in > 18yrs old
Spring TMS Indication
prevent & treatment > 12yrs old
Gammacore
prevention and treatment migraines > 12yrs old
Cefaly
prevention & treatment in pts over 18yrs old
Who should use migraine devices?
cant take other meds
prescribed by headache specialist
Acute migraine goals of therapy
Restore ability to function treat attacks rapidly and consistently minimize the use of backup/rescue meds optimize self-care utilize cost-effective management cause minimal to no side effects
pts not candidates for self care
recent trauma new onset > 50 under age 18 history of liver disease or alcohol abuse associated with fever complains of confusion,dizziness,etc
Migraine step up approach
use of NSAIDs and combo products 1st, then move up to other therapies
Migraine stratified care
Initial migraine treatment used on symptoms severe and headache related disability
What did DISC study show
stratified care wasn’t better
Triptans MOA
- vasocronstriction via activation or 5-HT1B (postsynap) receptors on smooth-muscle of blood cells
- presynap 5-HT1D receptors activity leading to blockade of release of vasoactive peptides from trigeminal neurons. also leads to blockade of NT and activation of 2nd order neurons = facilitate descending pain inhibitory systems
Sumatriptan DDI
avoid in use w/in 2 weeks of MOAI
Sumatriptan Clinical considerations
not recommended with severe hepatic impairment
SQ has fastest onset and has some of best efficacy data
Zolmitriptan DDI
Avoid in use w/in 2 weeks of MAOI
max single dose = 2.5, max daily = 5mg when used with cimetidine
Zolmitriptan clinical considerations
no renal adjustment
CYP1A2
avoid ODT/nasal spray in mod/sev hepatic impairment
Almotriptan DDI
Redce dose to 6.25mg when w/ CYP3A4 inhib
Eletriptan DDI
should not use w/in 3 days of potent CYP3A4 inhib
Eletripatn Clinical considerations
avoid in sev hepatic impairment
CYP3A4
Almotriptan Clinical considerations
contains sulfa group, CI in sulfa allergy
dose adjust renal/hepatic impairment
Rizatriptan DDI
5mg/dose, max of 3/day w/ propranolol
dont use w/in 3 weeks of MAOI
Frovatriptn Clinical considerations
less effective than other triptans
slower onset/longer duration
CYP1A2
Naratriptan clinical considerations
Renal/hepatic impairment
Triptans CI
CAD - angina, vasospastic angina, uncontrolled HTN,etc
hepatic disease
if have risk factors for CAD
Triptans ADE
Fatigue Dizziness flushing warm sensations somnolence paresthesia medication overuse headache
Triptan sensations
can go away by switching to another one