Migraine

Question 1

MOA and use Sumatriptan (Imitrex)

Answer 1

• 5-HT Agonist
• vasoconstriction
• symptomatic tx of migraine headache

Question 2

source of pain in migraine is thought to be due to what two phases

Answer 2

1. vasoconstriction
2. vasoldilation and pulsation

Question 3

first choice in clinical practice for migraine headache

Answer 3

• “triptan” : 5-HT agonists

Question 4

compare vasoconstriction capability of “triptans” vs ergotamine

Answer 4

• ergotamine are stronger vasoconstrictors

Question 5

toxicities of triptans

Answer 5

• due to vasoconstriction
  
  • cardiovscular toxicity

Question 6

MOA of Ergotamine

Answer 6

• acts on 5-HT receptors (less specific than triptan) and stimulates alpha receptors
• vasoconstriction
• previous drug for tx of migraine headache

Question 7

adverse effects of chronic use of Ergotamine

Answer 7

• chronic vasoconstriction
  
  • gangrene in fingers and toes
  • CNS effects: hallucinations

Question 8

MOA of Dihydroergotamine

Answer 8

• similar to ergotamine: acts on 5-HT receptors

Question 9

What drugs can be used for prophylaxis of migraine

Answer 9

• beta-blocker: propanolol
• CCB: verapamil
• antidepressants : amitriptyline, fluoxetine
• Clonidine
• valproic acid
• Topiramate
• Botulinum toxin type A and B
• angiotensin II receptor blockers

Question 10

contraindication of triptans

Answer 10

• cardiac disease, CV disease, CAD, PVD
• Not long term prophylaxis