migraine Flashcards
limit abortive treatment to _____
less than 2-3 days per week
mild-moderate abortive treatment
NSAID, acetaminophen
moderate-severe abortive treatment
triptans/ergots
when do we need preventative therapy
4 + attacks per month with disability at least 3 x per month
about 1 migraine a week
first line abortive
tripatns and nsaids
second line abortive
nsaids (ketoroloac, ketoprofen)
preventative tx first line
valproate
topiramate
metoprolol
propranolol
frovatriptan
preventative second line
amitrypyline
contraindications to triptans
use of ergot/triptan within 24 h
use of MAOi within 2 weeks
heart disease, angina, stroke,HTN, ischemic bowel disease, hepatic impairment
triptans warnings
MI
pain in chest, throat, neck
headache
serotonin syndrome
seizures
which triptan has caution with sulfa allergy and corneal opacities
almotriptan
triptans side effects
oral tingling, drowsiness, fatigue, chest tightening, flushing
triptans drug interactions
SSRIs/SNRIs
eletriptan drug interaction
3A4 inhibitors
ergot side effects
fibrosis, cold in extremtities, numbness
ergot warning
peripheral ischemia, fibrosis, vasoconstriction, cerebrovascualr events
drug interactions ergots
3A4s
calcitonin gene related peptide antagonists (CGRP)
abortive treatment
- rimegepant
- ubrogepant
- zavegepant
CGRP drug interactions
strong 3a4 inhibitors , DO NOT GIVE
pgp inhibitors
lasmitidan warnings
headaches, sedation, serotonin syndrome, driving impairment
which drug should you avoid driving for 8 hours after dose
lasmiditan
monitoring with lasmiditan
LFTs, BP, HR
rescue nasal spray med for abortive migraines
butorphanol
beta blockers for preventative therapy with doses
propranolol - 80-240 mg daily
metoprolol - 100-200 mg daily
beta blockers contraindicated in ___
reynauds and asthma
which drugs not FDA approved for preventative
tricyclic antidepressants
amitryptyline dose preventative tx
25-150 mg daily
atogepant side effects
nausea, constipation, fatigue
rimegepant
nausea, rash, dyspnea
valproate dosing preventative
500-1500 mg daily
topiramate dosing preventative
50-100 mg daily
natural product for migraines
butterbur/pesasites
150 mg/day
contrainidcation in pregnancy
ergots
valproate
warning in pregnant
triptans
topiramate
12 and older abortive therapy
alotriptan
sumatriptan/naproxen combo
zolmitriptan nasal spray
6 and older abortive therapy
rizatriptan
is sumatriptan spray fda approved in children?
no
efficacy in 6 older tho
12 and older prophylaxis
topiramate
