Migraine

Question 1

What are some symptoms of Migraine?

Answer 1

Nausea
Vomiting
Sensitivity to light and sound

Fever
Stiff neck
Rash
Confusion 
Seizures
Double vision
Weakness
Numbness
Chest pain 
Shortness of breath 
aphasia

Question 2

What are some common migraine triggers?

Answer 2

Hormonal Changes in woman 
Foods (alcohol, beer, red wine, aged cheese, chocolate, overuse of caffeine)  
Stress
Sensory stimuli
Changes in Wake-Sleep pattern 
Changes in the environment

Question 3

Diagnosis of Migraine

Answer 3

• HA last 4 - 72 hours
• HA have ≥ 2 of the following: unilateral location, pulsating, mod-severe pain, aggravated by physical activity
• 1 of the following: Nausea and/or Vomiting, photophobia and photophobia

Question 4

What are some natural products which can help with Migraines?

Answer 4

• Caffeine in combo with APAP or aspirin
• Butterbut
• Feverfew
• Magnesium
• Riboflavin

Question 5

What is the treatment for chronic Migraine?

Answer 5

Avoid triggers 
(no pharmacologic agent available for chronic just acute)

Question 6

True or False:
Opioids, butalbital-containng products, tramadol and tapentadol are not recommended for the treatment of Migraine due to abuse/dependence.

Answer 6

True

Question 7

What is the 1st line therapy for Migraine

Answer 7

Triptan

Question 8

Triptan MOA

Answer 8

Selective agonists for the 5-HT1 receptor and cause vasoconstriction of the cranial blood vessels

Question 9

Imitrex sig

Answer 9

25, 50, or 100 mg po can repeat once after 2 hours

Question 10

What is the max dose of Imitrex?

Answer 10

200mg/day

Question 11

Triptan contraindication

Answer 11

Cerebrovascular disease
Uncontrolled HTN
Ischemic heart disease

Question 12

Triptan warning

Answer 12

Increase BP

Question 13

Triptan ADE

Answer 13

Paresthesia (thinking/numbness)

Triptan sensation; pressure in the chest or heaviness or pressure I the new region

Question 14

What are the agents for Ergotamin class and what are their indications?

Answer 14

Dihydroergotamin (D.H.E. 45, Migranal) nasal spray

Indication: Migraine

Question 15

Dihydroergotamin Warnings and Contraindications

Answer 15

Warning:

• CYP3A4 inhibitor
• Can cause life threatening peripheral ischemia

Contraindications:

• Uncontrolled HTN
• Pregnancy
• Ischemic heart. disease

Question 16

Which Triptans are approved for children and adolescents ≥ 12 years?

Answer 16

Almotriptan
Zolmitriptan nasal spray
Treximat (Imitrex and naproxen)

Question 17

When would prophylactic Migraines med be recommended?

Answer 17

If patient is using acute treatment ≥ 2 days/week/month

Question 18

When are prophylactic Migraines meds not effective?

Answer 18

If patient is having and acute Migraine.

NOT for acute treatment

Question 19

What are some prophylactic Migraines meds?

Answer 19

Class: Calcitonin Gene-Related Peptide (CGRP) receptor antagonists:

• Aimovig monthly SC injection
• Emgality monthly SC injection
• Ajovy monthly SC injection
• Propranolol
• Topiramate
• Valproic acid
• Amitriptyline
• Venlafaxine

Question 20

When can Botulinum toxin type A (Botox) be considered for treatment?

Answer 20

For chronic Migraines ≥ 15 HA/month

Question 21

How does rebound headaches occur?

Answer 21

By the overuse of HA medications

Counsel patients to limit HA/Migraines medications to 2 - 3 times/week and to see MD if they need to use more.