Migraine

Question 1

Sumatriptan

Answer 1

1st line therapy

Specific 5-HT receptor agonist

Contraction of vessels in carotid circulation

Doesn’t cross BBB, other triptans do

Question 2

Dihydroergotamine

Answer 2

Extensive 1st pass metabolism - give i.m. & i.v. or nasally

Rapid onset

Crosses BBB, binds neurons in dorsal raphe nucleus

Contraindicated in pts. with HTN / ischemic heart disease

Question 3

Acetaminophen

Answer 3

Initial line of defense

Mild to moderate migraine pain

GI dysfunction

Question 4

NSAIDs

Answer 4

NSAIDS like aspirin ibuprofen, and naproxen, and acetaminophen): Often the initial “line of defense” against mild to moderate migraine pain. Effervescent preparations are most effective due to more rapid absorption. They are contraindicated in patients with active ulcer disease. Adverse effects include gi dysfunction (nausea, vomiting, dyspepsia, ulcer).

Question 5

Propranolol

Answer 5

Beta-Adrenergicblockers:nPropranolol,atenolol,etc.

Mode of action on migraine not understood.

Useful in patients with coexisting hypertension.

May cause hypotension and worsen asthma, congestive heart failure, atrioventricular block, depression, Raynaud’s

Question 6

Amitriptyline

Answer 6

Block uptake of serotonin. Takes 2-3 weeks for effect.

Useful for patients who have coexisting depression or “fibromyalgia”

Sedating, may cause weight gain, dry mouth, urinary retention; confusion in older adults.

Contraindicated in patients with glaucoma, prostatic hyperplasia, cardiovascular disease, and asthma

Question 7

Topiramate / Valproic acid

Question 8

Verapamil

Answer 8

Evidence for efficacy controversial.

May be useful in patients with coexisting Prinzmetal’s angina or Raynaud’s phenomenon.

Constipation may be troublesome.

Contraindications include hypotension and heart block.