Migraine Drugs

Question 1

the signals created by the migraine generator are carried by the _________ system

Answer 1

• trigeminovascular

Question 2

signals from the migraine generator induce the release of ______ from trigeminal sensory neurons in the dura mater and subarachnoid space

Answer 2

• calcitonin gene related peptide (CGRP)

Question 3

CGRP binds to its cognate receptor on vascular smooth muscle and causes __________

may also induce

Answer 3

• vasodilation
• inflammatory response
• sensitization of trigeminal sensory neurons

Question 4

data also show that the level of ______ in the brain decreases during migraines

role of this hormone

Answer 4

• serotonin
• induces vasoconstriction through 5HT-2A receptor
• blocks release of CGPR by agonizing the presynaptic 5HT-1B/D receptors on vascular smooth muscle

Question 5

stimulation of beta 2 receptors on vascular smooth muscle causes

MOA of beta blockers

Answer 5

• relaxation
• vasodilation
• promote vasoconstriction
• reduce cranial blood flow

Question 6

best beta blockers to use for preventing migraines

Answer 6

• propranolol

Question 7

toxicities of beta blockers

Answer 7

• arrhythmias

- hypotension

Question 8

examples of calcium channel blockers

Answer 8

• verapamil

Question 9

MOA of calcium channel blockers in preventing migraine

Answer 9

• inhibit vascular smooth muscle contraction (which is weird because vasodilation is the problem normally)
• reduce BP

Question 10

MOA of tricyclic SNRI anti-depressants in treating migraine

Answer 10

• increase synaptic concentrations of serotonin and NE
• promote serotonin-induced vasoconstriction in cranial arteries
• reduce likelihood that stress acts as a trigger for migraine attack

Question 11

example of tricyclic SNRI used to treat migraines

Answer 11

• amitriptyline

Question 12

toxicities of tricyclic SNRIs

what population do we not use these in?

Answer 12

• anti-cholinergic
• xerostoma, constipation, urinary retention, blurred vision
• not recommended in the elderly

Question 13

the anti-seizure drugs ____ and ____ are first-line drugs in the prevention of migraines

MOA

Answer 13

• valproate
• topiramate
• may influence signaling pathways associated with the migraine generator

Question 14

MOA of Erenumab

how often do you have to administer

Answer 14

• binds to CGRP receptor and prevents CGRP from activating it
• 4-12 weeks

Question 15

MOA of Fremanezumab

how often do you have to administer

Answer 15

• binds CGRP itself and blocks binding to receptor

- 4-12 weeks

Question 16

MOA of Galcanezumab

how often do you have to administer

Answer 16

• binds CGRP itself and blocks binding to receptor

- 4-12 weeks

Question 17

toxicities of the CGRP and CGRP receptor antibodies

Answer 17

• injection site reaction

Question 18

drugs for the acute treatment of migraines

Answer 18

• ergotamine

- triptans

Question 19

MOA of triptans

route of administration

Answer 19

• serotonin 5HT-1B/D presynaptic autoreceptor agonist
• inhibit release of CGRP
• oral

Question 20

MOA of dihydroergotamine

route of administration

Answer 20

• serotonin 5HT-1B/D presynaptic autoreceptor agonist
• alpha 1 stimulator to induce vasoconstriction and reduce local blood flow
• IV

Question 21

toxicities of triptans

Answer 21

• paresthesia (tingling, numbness, itch, tactile feelings)

- transient spike in BP, myocardial ischemia and stroke secondary to vasoconstriction

Question 22

toxicities of dihydroergotamine

Answer 22

• induce uterine smooth muscle contraction (pregnancy category X)
• transient spike in BP, myocardial ischemia and stroke secondary to vasoconstriction

Question 23

which migraine drugs do you also have to be careful with because of serotonin syndrome

avoid with

Answer 23

• triptans
• dihydroergotamine
• SSRIs, SNRIs, and MAOIs