Migraine

Question 1

When can you be diagnosed with migraines?

What hormone pills are recommended in women?

How do the triptans work and what are their names?

Answer 1

5 attacks. Headaches that last 4-72 hours, unilateral location and pulsating, N/V, photophobia or phonophobia.

Progestin only pills are recommended for women with migraine with aura.

Agonists for the 5-HT1 receptor, vasoconstriction of cranial blood vessels. 1st line for acute treatment. Sumatriptan (imitrex, imitrex statdose), _ naproxen is Treximet.

Question 2

What are the dosing and side effects of the triptans?

Answer 2

ODT Rizatriptan, SC (autoinjector and prefilled syringe), nasal spray and powder of Sumatriptan. Zolmitriptan is ODT and nasal spray. CI’d in cv disease, uncontrolled hypertension and ischemic heart disease, use within 24 hours of another. Increase BP, paresthesia, triptan sensations, ODTs, nasal spray and injections are useful if nausea is present and they work faster. 1 dose(do not prime) of imitrex and zomig. Treximet needs to be in original container. Almotriptan tabs and zolmitriptan spray and treximet are for kids, rizatriptan for 6-17. Frova and nara are long acting but slow onset, rest are short half live but faster onset. Sumatriptan is SC in lateral thigh or upper arm.

Question 3

What to know about the ergotamine drugs?

What are your oral prophylactic agents and what to know about them?

What is the CGRP antagonist?

Answer 3

non selective serotonin agonist. Use with patients who cant use or have no benefit in triptans. Dihydroergotamine (DHE 45, migranal). Potent cyp3A4 inhibitor causes life threatening peripheral ischemia. CV effects, drug interactions, prime nasal spray.

Propanolol (inderal LA), Divalproex, Topiramate. Depakote causes fetal harm and hepatic failure, Most lipophilic is propanolol. Weight gain, thrombocytopenia, increased ammonia and alopecia is depakote. Topiramate is fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis. Weight loss (6-13%), somnolence, cog impairment.

Aimovig, MAB for prevention. Botox is for chronic only.