Migraine Flashcards
Cortical Spreading Depression in a migraine elevates levels of extracellular…
K, H, NO, AA
5HT receptor roles in the trigeminovascular system
1B – Vasoconstriction
1D – Inhibition of NT release
1F – inhibit release of nociceptive molecules
Drugs/Types used to abort migraines
Acetaminophen
Aspirin/NSAIDS
Serotonin Agonists
Drugs/Types used to prevent migraines
beta blockers
tricyclic antidepressants
anticonvulsants
botox
Important Analgesic combinations used in Migraine treatment
Excedrin Migraine - Acet., Asp., Caffeine
Migralam - Acet., Caff., Isometheptene
Midran - Acet., Isometheptene, Dichlorophenazone
Migraine treatments to avoid whenever possible because they include opoids
Fiorinal, Fiorice
Butorphanol
Hydromorphone, Oxycodone
Antiemetics used as adjunct treatment in Migraine
Metoclopramide (inc. gastric emptying –> increase abs)
Symptoms of Ergot poisoning
Nausea/Diarrhea/Vomiting
Gangrenous Limbs
Psychoses
Spontaneous Abortions
Ergot alkaloids used to abort migraine include…
Ergotamine
Dihydroergotamine
Hoe do ergot alkaloids work
They are 5HT 2a/1b/1d/1f agonists + alpha 1 agonists
Absorption data on ergot alkaloids
Ergotamine – Sublingual tablets
DHE – IM Injection/Nasal Spray
Important ergot alkaloid drug interactions to be aware of
HIV protease inhibitos, macrolides raise them
DHE decreases nitrate efficacy
Sumatriptan important details
Synthetic 5HT 1b/D/F agonist
Faster onset than DHEm but shorter half life, so it can allow for headache recurrence
Naratriptan important details
Slower onset, longer duration of action, lower recurrance than sumatriptan
Frovatriptan important details
Tricyclic Structure, orally active
2-4 hrs to onset, but 26 hour half life
Triptan contraindications
- Precipitate angina – not for CAD patients
- Sumatrip. – Not w/ MAOIs
- Naratriptan – Not w/ Severe hepatic/renal impairment, PVD
Zolmitriptan contraindication
WPW Syndrome
Rizatriptan contraindication
not for PKU patients
What is status migrainosus? first line treatmnet?
Headache over 72 hours w/ or w/out treatment
Treat w/ Triptans (subQ suma)
First line agents to prevent migraines
beta blockers (propanolol, timilol)
Topiramate
Tricyclics
Valproic Acid
How does botox prevent migraines?
Toxin light chains cleave SNAP25, inhibiting NT release
Axonal transport from periphery to meninges
When is it appropriate to use Botox to treat migraine
Chronic migraine (15/month for 3 months)
Use other drugs at least 10 days/month
Headache worsening
