migraine Flashcards
two classes for migraine tx
1) acute tx
2) prevention
mild to moderate migraines
non-opioids
acetaminophen
NSAIDs
mod to severe migraine DOC
triptans
triptan
agonist 5 HT1D/1B
triptan AE
vasoconstrictors: so contraindicated in coronary/cerebrovascular disease
vasospams can occur - chest tightness
ergotamine/dihydroergotamine
agonist at alpha, 5HT, D2
prevention of migraines 1st line (3)
beta blockers
valproate
topiramate
2nd/3rd line prevention migraines
TCA SNRIs CCB gabapentin ACEI/ARB botulinum NSAIDs
beta blockers used in migraines (first line)
atenolol timolol nadolol metoprolol propanolol
valproate MOA
block Na and T type Ca VG channels
topiramate MOA
block VG Na. Antagonist at GABA(a) and glutamate receptor
TCAs used in migraine tx
amitryptaline
nortryptiline
imipramine
SNRIs used in migraine tx
venalfaxine
CCBs used in migraine tx
verapamil: greatest efficacy of CCBs
gabapentin - dec glutamate release
ACEIs and ARBs used in migraine tx
lisinopril
candesartan
NSAIDs used in migraine tx
naproxen, ibuprofen
for frequent but mild migraines
ergot alkaloids AE
n/v
vascular occlusion with gangrene in OD cases
dihydroergotamine = weaker vasoconstricter, less AE
contraindicated in arterial dz or uncontrolled HTN
valproate AE
GI, thrombocytopenia, teratogenic
topiramate AE
somnolence, fatigue, cognitive slowing, acute myopia, glaucoma, hyperthermia, renal stones
teratogenic
TCA AE
sedation
dry mouth
weight gain
TCA MOA
inhibit NE and serotonin reuptake
venlafaxine AE
nausea, constipation, insomnia, sexual dysfunction
