Migraine Flashcards
What three neuropeptides are released during migraines
Subbstance P
CGRP
Neurokinin A
When do you qualify for migraine prophylaxis ?
> 3 / month or lasting >12H or associated with disabilityWha
What are the two beta blockers approved for migraine prophylaxis?
What are 5 OTC’s for prophylaxis?
Propranolol and timolol
Butterbur, feverfew, riboflavin, magnesium citrate, CoQ10h
What is first line for migraine prophylaxis?
What if they have:
1. Raynauds
2. Depression
3. Epilepsy
4. Insomnia
5. Obesity
Amitriptyline , BB, topiramate, or CGRP antagonists
- Verapamil
- Amitriptyline or venlafaxine
- Valproate or topiramate
- Amitriptyline
- Topiramate
Basic Treatment options for acute migraine attack
Aspirin
Excedrin
NSAIDS
Nodolor
Butalbital
Triptans
Ergot alkaloids
Mild to moderate migraine attack treatments with NO vomiting
ASA
NSAID
Tylenol
Moderate to severe migraine attack treatment
- NO vomiting
- With vomiting
- Triptan or Treximet
SQ Imitrex
Nasal imitrix or zolmitriptan
Dihydroergotamine
What are three anti-nausea medications during migraines
Metoclopramide
Prochloperazine
Chlopromazine
Which triptans are recommended for kids 6-11?
Maxalt (rizatriptan)
Imitrex nasal spray
Naratriptan
Brand
Form
Max dose
Wait between doses
Onset
Amerge
Tabs
5mg/day
> 4 hours
Slowest
Rizatriptan
Brand
Form
Max dose
Wait between doses
Maxalt ,
Tabs and ODT
30mg/day
> 2 hours
Sumatriptan
Brand
Form
Max dose
Wait between doses
Imitriex - PO - max 200mg/d , >2H
SQ - 12mg/ d , >1H
Zembrance - SQ - 12mg/d , >1 H
Onzetra - Nasal powder - 44mg/d - >2H
Tosymra - nasal , max 30mg/d , >1H
Onzetra
Generic
Counseling
Sumatriptan nasal powder
Breath actuated - place in nostril and blow into the mouth piece to release drug into nose
Treximet
Components
Max
Wait between doses
Sumatriptan 85mg and naproxen 500mg
170/1000mg /day
> 2 hours
Zolmitriptan
Brand
Form
Max dose
Wait between doses
Zolmig
Tab
ODT
Nasal spray
10mg/day
> 2H
Almotriptan
Brand
Age
Form
Max dose
Wait between doses
Axert
> 12y.o
tabs
25mg/d
> 2H
Frovatriptan
Brand
Form
Max dose
Wait between doses
Onset
Frova
Tab
7.5mg/d
> 2H
Slowest onset
Eletriptan
Brand
Form
Max dose
Wait between doses
PGx
Relpax
Tabs
80mg/d
> 2H
CYP3A4 Substrate - don’t use within 72 hours of taking a 3A4 inhibitor
Ergots
MOA
Cautions
ADE
Interactions
Vasoconstriction , interacts with 5HT, DA, and NE
Hepatic/renal impairment, CAD, HTN
N/V, numbness, weakness
BB , 3A4 inhibitors (will increase ergot concentration)
Dihydroergotamine mesylate
Brand
Forms
Migranal - nasal spray combines with caffeine
D.H.E 45 - IM/SUBQ/IV
Ergotamine + Caffeine
Brand / Forms / dose
Cafergot - tabs
1mg ergotamine , 100mg caffeine
Max 6 tabs/attack or 10t/week
Migergot - SUPPOSITORIES
2mg ergotamine, 100mg caffeine
2S/attack or 5 s/week
Butalbital / Caffeine / APAP
Brand
Forms
Max
Fiorecet/ Esgic
Tabs
6t/d
Butalbital / Caffeine / ASA
Brand / schedule
Forms
Max
Fiorinal C3
tabs
6t/d
Nodolor
Componenets
Schedule
Max
Isometheptene 65
Dichloralphenazone 100mg
APAP 325
C4
5 caps/12H
Excedrin
Components
Max
Indication
Pregnancy?
APAP, ASA, Caffeine
2 t/ day for migraines
Treatment of migraines
NO, category D
Erenumab
Brand
MOA
ROA / dose
Indication
Aimovig
CGRP Antagonist
70-140mg SQ Monthly
Migraine prophylaxis
Fremanezumab
Brand
MOA
ROA / dose
Indication
Ajovy
CGRP antagonist
225mg monthly or 675 mg every 3 months
Migraine prophylaxis
Galcanezumab
Brand
MOA
ROA / dose
Indication
Emgality
CGRP Antagonist
240mg SQ start then 120mg SQ monthly
Migraine prophylaxis
Atogepant
Brand
MOA
ROA / dose
Indication
Qulipta
CGRP antagonist
10-60mg QD PO
Migraine prophylaxisis
Rimegepant
Brand
MOA
ROA / dose / max
Indication
Nurtec ODT
CGRP antagonist
PPX - 75mg PO QOD (Max 75mg/day)
TX - 75mg ODT single dose
Migraine PPX and Tx
Ubrogepant
Brand
MOA
ROA / dose / max
Indication
Ubrelvy
CGRP antagonist
50-100mg PO (max 200mg/d)
Migraine Tx
Zavegepant
Brand
MOA
ROA / dose
Indication
Zavzpret
CGRP antagonist
one NASAL spray in 1 nostril per day
Lasmiditan
Brand
MOA
ROA / dose
Indication
benefit
Reyvow
serotonin 5HT`F agonist
50,100,200mg / dose / day
Migraine Tx
Does not cause vasoconstriction
Acute treatment and prevention of cluster headaches
Acute - Oxygen and subQ sumatriptan
Prevention - verapamil or emgality
