Migraine Flashcards
What is the MOA of triptans
5-HT1 receptor agonists causing vasoconstriction of the cranial blood vessels
When are triptans best used
At the 1st sign of a migraine
What are the natural products for a migraine
Caffiene, Butterbur, feverfew, magnesium, riboflavin
Common Migraine Triggers
1) Hormonal Changes - i.e. estrogen
2) Food - i.e. alchohol (beer, red wine), aged cheeses, chocolate, aspartame, caffiene overuse, MSG, salty/processed foods
3) Stress
4) Sensory stimuli i.e. flashing lights
5) Sleep Changes
6) Enviornmental Changes
Maxalt
Rizatriptan
Imtrex
Sumatriptan
Onzetra
Sumatriptan
Zomig
Zomatriptan
DHE
Dihydroergotamine
Migranal
Dihydroergotamine
Inderal
Propanolol
Lopressor
Metoprolol Tartrate
Torol XL
Metoprolol Succinate
Depakote
Divalproex
Topamax
Topiramate
Metoprolol Succinate is also preferred in what condition
Heart Failure
Which triptans are available ODT
Rizatriptan (mAxalt) and Zolmitriptan (zolmig)
Which triptans are available via nasal spray
Sumatriptan (Imirex) and Zolmitriptan (Zomig)
Which Triptan is available as a SC injection
Sumatriptan (Imitrex)
Which triptan contains Phenylalanine and should not be used in PKU?
Rizatriptan (Maxalt)
Boxed warnings for triptans
Vasoconstricts therefore do not use in cardiovascular disease, also contraindicated with MAO inhibitors (seritonergic)
Side effects of triptans
paresthesia (tingling and numbness) and triptan sensations
Which formulations are preferred if nausea is present?
ODT, nasal sprays, and injections
Treximet
Sumatriptan + Naproxen
Triptans with longer half life but with slower onset
Frovatriptan and Naratriptan
Which triptans are contraindicated with MAO inhibitors
Sumatriptan, Rizatriptan, Zolmitriptan
MOA of ergots
Nonselective agonist of seratonin receptors
ergot boxed warning
do not use with potent CYP inhibitors due to life threatening peripheral ischemia
ergot contraindications
pregnancy, uncontrolled hypertension, ischemic heart disease
triptan vs ergot nasal spray
triptan nasal spray is just 1 dose so do not prime but for ergots you do have to prime 4 times
Fiorcet
Acetaminophen/butalbital/caffiene
Fiorinal
Aspirin/butalbital/caffiene
When to recommend a prophylactic migraine to a patient
If they use acute treatments greater than two days per week or three days per month
Topamax
topiramate
Which antidepressant can be effective for ppx
tricyclic (amitriptyline) or venlafaxine
Which antiepileptic drugs can be effective for ppx
Topiramate or valproic acid
Which antihypertensive is most effective for prophylaxis?
BB specifically propanolol but other antihypertensive types have been used
Warnings and side effects of beta blockers
Use caution with bronchospastic disease (esp propanolol and timolol non selective)
Side effects of beta-blockers
Can cause bradycardia, fatigue, hypotension, dizziness, depression, impotence, and can exacerbate raynauds
Which is the most lipophilic bb
propanolol, therefore, crosses the blood-brain barrier the best
boxed warnings for Divalproex and valproic acid
fetal harm, hepaitc failure
boxed warnings for topiramate
fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angel glaucoma, oligohidrosis
Which CGRP receptor antagonist is given IV every 3 months and which is given ODT
epitinezumab (Vyepti) every three months and rimegpant ODT
limitation for headache overuse
2-3 times per week for the offending agents
how to use Onzetra Xsail
Sumatriptan nasal powder - blow into mouth for 2-3 seconds to deliver into nose
Migraine diagnosis criteria
At least five attacks fulfilling the following:
1) headaches that last 4-72 hours
2) unilateral location, pulsating
3) nausea, and/or vomiting, photophobia (sensitivity to light) and phohophobia (sensitivity to sound)
valproic acid/divalproex vs topiramate weight effects
topiramate weight loss while the other to are the opposite
