Migraine Flashcards
What type of migraine puts you at a higher risk for stroke?
Migraines with aura
What is used to treat menstrual associated migraine?
oral constraceptives (monophasic might be the best to reduce estrogen fluctuations)
estradiol patch
How do you diagnosis migraines?
When you have at least 5 attacks with:
-headache lasting 4 - 72 hours
-at least 2 symptoms of unilateral local, pulsating, moderate to severe pain or aggravated by physical activity
-at least 1 of the following: nausea, vomiting, photophobia, phonophobia
What is first like treatment for ACUTE treatment of migraines?
Triptans
-Rizatriptan (Maxalt-MLT)
-Sumatriptan (Imitrex)
-Zolmitriptan (Zomig ZMT)
Triptans
Receptor agonist for 5-HT1
-Rizatriptan (Maxalt-MLT)
-Sumatriptan (Imitrex)
-Zolmitriptan (Zomig ZMT)
CI: CVD (stroke), uncontrolled HTN, ischemic heart disease
Warning: serotonin syndrome!!!!!!
SE: paresthesia (numbness), heaviness in the chest or neck (triptan sensations)
What 1st line acute treatment for migraines is approved for 6-17 year old patients?
Rizatriptan (Maxalt-MLT)
What formulations of triptans work the fastest to releave a migraine?
SC injection and nasal sprays
SC - sulmatriptan
nasal - sumatriptan and zolmitriptan
What can be used as 2nd line for acute treatment of migraines when triptans do not benefit?
Ergotamine (non-selective serotonin receptors)
- Dihydroergotamine (DHE 45, Migranal)
- Ergotamine + caffeine
CI: uncontrolled HTN, ischemic heart disease, pregnancy
Warning: CV effects, cerebrovascular events
VASOCONSTRICTION (ergotism)
**drug interactions —- avoid with strong CYP3A4 inhibitors
What drug that treats acute migraines does NOT cause vasocontriction?
Lasmidtan (Reyvow)
C-V
*****CNS depression!!!!!
Anti-abortive migraine agents
Triptans
Ergotamines
CGRP receptor antagonists (Rimegepant and Ubrogepant)
Lasmiditan (selective 5-HT1F)
What are options for prophylaxis of migraines?
-beta blockers (propanolol)
- Topiramate and Valproic acid
- Amitriptyline and Venlafaxine
-CGRP antagonists
-COC
What natural products may be used for migraines?
Caffeine!!!!
Butterbur
Feverfew
Magnesium
Riboflavin
What CGRP antagonists are approved for prophylaxis of migraines?
Rimegepant
Atogepant
Injectables:
Eptinezumab
Erenumab
Fremanezumab
Galcancezumab
What prophylactic migraine agent causes increase ammonia?
Topiramate (Topamax)
-fetal harm
-metabolic acidosis
-nephrolithiasis
-open angle gluacoma
-oligohidrosis
A patient comes in looking for a prophylactic migraine medication. She is overweight and does not want a medication that could cause her to gain any more. What medication should she AVOID? What medication could you recommend for weight loss and prophylaxis?
Divalproex AVOID
recommend Topamax
