Migraine Flashcards
What are some of the symptoms of a Migraine?
- Nausea
- Vomiting
- Sensitivity to light and sound
- Flashes of light, bloind spots or tingling in arms or legs (AURA)
What are some common migraine triggers?
- Hormonal Changes in women
- Foods
- Stress
- Sensory Stimuli
- Wake-sleep patterns (too much or too little)
- Weather
What is the Diagnosis for Migraines?
- 5 attacks of …
- Headaches last 4 - 72 hours
- Headaches with > 2 of: Unilateral location, pulsating, mod-severe pain aggravated my physical activity
- one of the following during: N and/or V, Photophobia, Phonophobia
What are some of the natural products that could be used for Migraines?
- Riboflavin
- Magnesium
- Butterber
- Feverfew
- Topical Peppermint
What are some of the Acute OTC Drugs used for migraine?
- Tylenol
- Aspirin
- Advil Migraine (only has Ibuprofen)
- Naproxen
- Excedrin Migraine (Aspirin, Tylenol, Caffiene)
What are some Rx Options for Migraines?
- High dose NSAIDs
- Triptans
- CGRP Receptor Antagonists
- Ergotamines
- Lasmiditan
What are some drugs that are NOT recommended to help with Migraines?
- Butalbtal-containing products
- Opioids
- Tramadol
- Tapentadol
Because of decreased efficacy, abuse potential, and risk of rebound headaches
What is the MOA for the Triptans used for migraines?
- agonist for serotonin receptors = vasoconstrict crainal blood vessels
1st line
BEST USED at the first signs of migraine
What are some of the triptan drugs that are used for migraine?
- Almotriptan
- Eletriptan
- Frovastriptan
- Naratriptan
- Rizatriptan (Maxalt-MLT) (ODT)
- Sumatriptan (Imitrex [Nasal Spray, SubQ Injector]; Onzerta Xsail [Nasal Powder])
- Zolmitriptan (ODT, Nasal Spray)
What are some of the contraindications for the Triptans used for Migraines?
- Stroke
- Uncontrolled HTN
- Ischemic Heart Disease
- Drug interactions with MAOi and 3A4
What are some of the Warnings for the Triptans used for Migraines?
- Risk of Increasing BP
- Serotonin Syndrome
What are some of the side effects for the Triptans used for Migraines?
- Tingling/numbness, dry mouth, vision loss, nausea, unpleasent taste
- “Triptan Sensations” (Pressure or heaviness in Chest or Pressure in Neck)
What are some of the additional notes for the Triptans used for Migraines?
- ODTs, Oral Films, Nasal Sprays, Injections are best when patient has Nausea
- Nasal Sprays ONLY have ONE dose (NOT priming)
- Treximent (SubQ Injection): Dispense in OG container
- Maxalt-MLT ODT: NOT used with Phyeylkatouria
Which triptans are approved for the use in Childern and Adolescents with migraines/
- Almo tabs, Zolmi nasal spray, Riza film, Treximet: > 12 year old
- Riza tabs & ODT: > 6 years old
Which triptan has the longest duration of action and what is the benefit of choosing them?
- Frova = 26 hours
- Have shorter onsets BUT can be used if the headache recurs after dosing
What is the MOA of the ergotamine drugs used for migraines/
- nonselective agonist of serotonin receptors = cerebral vasoconstriction
What are some of the ergotamine drugs that are used for migraines?
- Dihydroergotamine (Migranal) [Injection (IM, SubQ, IV), Nasal Spray]
- Ergotamine (Ergomar)
- Ergotamine + Caffeine (Mirgergot, Cafergot*)
- Cafergot is Discontinued but still referred
What are some of the Boxed Warnings for the Ergotamine drugs used for Migraines?
- with Potent 3A4 inhibitors = life threatening peripheral ischemia
What are some of the Contraindications for the Ergotamine drugs used for Migraines?
- Uncontrolled HTN
- Ischemia Heart Disease
- Pregnancy
- Use with 24h of serotonin agonist (triptans) or other ergotmine drug
What are some of the warnings for the Ergotamine drugs used for Migraines?
- Cardio Effects
- Cerebro Events
- Serious Drug interactions
What are some of the Side effects for the Ergotamine drugs used for Migraines?
- Nausea, Vomiting
- With Nasal Spray: Rhinitis, Dysgeusia, Local Irritation
What are some of the additional notes for the Ergotamine drugs used for Migraines?
- Nasal Spray: prime with 4 pumps; do NOT inhale deeply, use at the first sign of attack
What is the MOA for the CGRP Receptor Antagonist used for Migraines?
- CGRP normally causes vasodilation and neruo inflammation = blocking CGRP will reduce or eliminate pain
What are some of the CGRP Receptor Antagonists that are used for migraines?
- Rimegepant (Nurtec)
- Ubrogepant (Ubrelvy)
- Zavegepent (Zavapret)
