Migraine And Meds

Question 1

How can bv meninges and mm around the head to stimulated to cause pain in 2nd headaches

Answer 1

Bv spasms- vasculitis
Increased pressure- tumour
Inflammation- meningitis
Increased mm tension- temporomandibular disorder

Question 2

Primary headaches

Answer 2

Tension- dehydrated, no sleep, hrs
Migraines- irritability, depression, fatigue, hrs to days, strange smells osmophobia, lights, visual disturbances, n and v
Cluster- few times a day of stabbing pain around eye, alarm clock, mins to hrs, swollen eyelid, red eye, tearing, runny nose, miosis, ptosis, anhidrosis (decreased sweating)= horners syndrome

Question 3

Migraine clues

Answer 3

High conc of serotonin increase triggering vasoconstriction (might trigger cortical spreading depression where brain becomes hypertensive to light, sounds, smells) and low conc during attach of migraine triggers vasodilation
This change could trigger pain receptors

Question 4

Treatment for primary

Answer 4

Acute acetaminophen NSAIDs to manage pain
Preventative
Tension= pain med to improve sleep, reduce stress, tricyclic antidepressants
Migraines= during early symptoms, triptans, ergotamine (serotonin agonists) and caffeine, b blockers, ca block, tricyclic antidepressants, anti seizure (valproate)
Clusters= oxygen, triptans, verapamil

Question 5

Acute treat migraine

Answer 5

Common analgesic drugs like NSAIDs and butorphanol that work best at first sign of attack for mild, mod symptoms
Triptans and ergot alkaloids for severe pain= serotonin agonist causing vasoconstriction

Question 6

Triptans

Answer 6

Don’t respond or severe
End in triptans and given by mouth but also SC and nasal
5- HT1B and 5-HT1D serotonin receptors preventing vasoactive peptide release so no trigeminal nerve activation so cause vasoconstriction
Se mild pain or burning at site of injection, parenthesis, fatigue, dizzy, raise BP, coronary vasospasm- angina
Don’t give in coronary disease, HPT, angina, peripheral vascular disease
Rarely cause myocardial ischemia/ infarction

Question 7

Serotonin syndrome

Answer 7

When triptans r used w other serotonin agonists like ergot alkaloids
Headaches, hallucinations, coma
Tremors, hyperflexia
Tachycardia, nausea, diarrhoea, shivering, sweating

Question 8

Ergot alkaloids

Answer 8

Ergotamine- sublingual tablets
Dihydroergotamine- injected or nasal spray
Agonists at 5HT serotonin receptors but not specific so more se
N and v, vasoconstriction so contraindications in coronary disease, HPT
Contractions of uterine smooth mm- oxytocin effect so no used in preg
Metab in liver so dont use in impaired liver
Leg weakness and mm pain

Question 9

Ergotism- intoxicate w ergot alkaloids

Answer 9

Spasms, seizures, psychiatric symptoms, gastrointestinal symtoms, gangrene in hands and feet
Use anticoagulant, vasodilations and low molecular weight dextran to treat these

Question 10

Prophylactics treatment

Answer 10

B blockers propranolol, nadolol, timolol, metaprolol
Ca blockers like verapamil
Tricyclic antidepressants like amitriptyline
Anti seizure medications like topiramate
Onobotulinumtoxin a (Botox) to block neurotransmitter release from trigeminal sensory nerve so blocks pain

Question 11

Anti CGRP antibodies

Answer 11

Erenumab, fremanezumab, galcanezumab
All SC
Mab that block calcitonin gene related peptide or its receptor so blocks sensory nerve impulses throughout the trigeminal nerve
Only pain at injection as se and not metab by liver