Migraine

Question 1

4 Classes of Drugs used for ACUTE treatment of Migraine

Answer 1

Triptans

Ergot Derivatives

Analgesics

Antiemetic Drugs

Question 2

4 Classes of Drugs used for DAILY treatment of Migraines

Answer 2

Anticonvulsants

BB’s

Ca Blockers

Herbal Preparations

Question 3

Analgesics

Answer 3

both simple and combination used, many OTC

include: aspirin, caffeine, acetaminophen, ibuprofen
* WATCH for rebound headaches

Question 4

Ergot Derivatives

Answer 4

• more of a historical treament
• oral and suppository form
• causes vasoconstriction
• avoid caffeine, activities requiring alertness, and long term use is bad due to pericardial/pleural fibrosis

Question 5

Contraindications or Ergot Derivatives

Answer 5

hypersensitive to ergotamine, caffeine

peripheral vascular disease

hepatic/renal disease

Pregnancy Category X

Question 6

ARD’s of Ergot Deriviatives

Answer 6

tachycardia, arterial spasm

numbness in fingers or toes

drowsiness, dizziness

nausea, vomit, diarrhea

Ergotism

Question 7

What do patients with Ergotism present with?

Answer 7

lots of vomitting

bradycardia

seizures

renal failure

Question 8

Triptans

Answer 8

cause vasoconstriction of cranial arteries, decrease sensory activation, affect trigeminal nucleus

• should be used to treat at least 3 migraines before trying a new drug
• failure with 1 Triptan does not imply that another will give relief
• rebound HA’s with more than 2 doses per week

keep a headache diary

Question 9

Triptan Contraindications

Answer 9

Ischemic heart disease

Uncontrolled HTN

MAOI’s

hypersensitivity to any component

use with Ergotamines or any other 5HT1 agonist

Pregnancy Category C

Question 10

Triptan Warnings/Precautions

Answer 10

MI/tachyacardia

elevated BP

colonic ischemia

Question 11

ADR’s of Triptans

Answer 11

dizziness

hot flashes

injection site reactions

paresthesias

diaphoresis

chest tightness (do first dose with EKG?)

Question 12

Drug interactions with Triptans

Answer 12

MAOI’s
8
SSRI’s

Ergotamine Derivatives

Question 13

Triptan Onset of Action

Answer 13

15 mins with SQ injection

30 mins with nasal spray

45-60 with oral tablet

Question 14

Triptan Special Issues

Answer 14

• take at the 1st sign of a migraine
• may repeat oral dose after 2 hours if little or no releif
• cannot exceed 2 injections in 24 hours
• pills cost appox $15 per, insurance often give 9 a month

Question 15

Sumatriptan (Imitrex)

Answer 15

50 and 100 mg doses eliminate migraine pain in over 60% of patients within 2 hours

stops migraine pain but it improves migraine induced cognitive impairment

oral and injectable

Question 16

When are Sumatriptan injections most useful?

Answer 16

when N/V present

Sumavel

Alsuma

Question 17

Zolmitriptan (Zolmig)

Answer 17

oral and melt preparations

-can effectively treat migraines for 90 mins, may reduce risk of allodynia (painful response to a non-painful stimulus) ex. combing hair

Question 18

Rizatriptan (Maxalt)

Answer 18

tablet or disintegrating disc (great for patients w/o water)

very effective with nausea

interaction with propanolol, cut dose in half due to doubling concentratin of Maxalt

Question 19

Naratriptan (Amerge)

Answer 19

longer duration, half life of 6 hours

low recurrence of HA

slower onset, well suited for patients who have longer lasting, slower developing migraines

very effective in preventing migraine associated with menstrual cycles

Question 20

Almotriptan (Axert)

Answer 20

NO PEDIATRIC INDICATION

max dose of 25 mg per 24 hours

Question 21

Frovatriptan (Frova)

Answer 21

stands out for long half life of 26-30 hours

Question 22

Eletriptan (Relpax)

Answer 22

newest on market

oral dose of 20 or 40mg

good SE profilfe

Question 23

Treximet (combo drug)

Answer 23

combo of Naproxen sodium 500 mg and sumatriptan 85mg

indicated for acute migraine