Migraine Headaches Flashcards
Analgesics used to treat migraine?
ASA APAP Ibuprofen Naproxen \+/- Caffeine
Anti-emetic agents
Dopamine receptor antagonists
Dopamine receptor antagonists
Metocloproamide
Prochlorperazine
Effects of DA receptor antagonists
Relieve N/V
Increase GI motility
Problem with administering DA receptor antagonists
Decreased gastric emptying means that parenteral route may be needed
MOA of Metoclopramide
D2 Receptor antagonist
Muscarinic receptor stimulator
Blackbox warning of Metoclopromide
Tardive dyskinesia (Parkinsonian symptoms) due to decreased DA
Which DA receptor antagonist only has effect at the D2 receptor?
Prochlorperazine
Which DA receptor antagonist does not have persistalsis activity?
Prochlorperazine
Use of Prochlorperazine
Alternative to Metoclorpramide
Which drugs are the migraine specific 5-HT1 agonists?
Triptans and Ergot alkaloids
What is the mechanism of action of Triptans?
5HT1 receptor agonist selective for 1B and 1D (vasoconstriction, block release of CGRP)
What are the effects of triptans?
relieve pain, reduce N/V, increase GI motility
Which migraine specific meds are not good for migraines with aura?
triptans
Why do you need to use NSAID adjuncts with Triptans?
Triptans have a short half life and usually do not last long enough to cover the headache
Contraindication of Triptans?
CAD - vasospasm (angina)
MAOIs (serotonin syndrome - 5HT1 agonist)
Why should Triptans not be given by IV?
Because they cause vasospasm (angina)
Which drug is the first line for ACUTE migraine?
Sumatriptan
Which drug is used as prophylaxis for menstrual migraines?
Frovatriptan
which triptan has a long half life of 26 hours?
Frovatriptan
Which drugs are used as an alternative to triptans?
Ergot alkaloids (Dihydroergotamine)
What is the main side effect of Ergot Alkaloids?
Ergotism - intense vasoconstriction of coronary arteries and peripheral arteries, angina, gangrene
What is the main Ergot Alkaloid used?
Dihydroergotamine
What is the MOA of Dihydroergotamine?
Non-specific agonist, partial agonist and antagonist on 5HT-1, A-adrenergic, DA receptors
What patients should avoid Dihydroergotamine because of higher risk of Ergotism?
Patients on CYP34A inhibitors
What are the prophylactic agents used for migraine?
Propanolol
Amitriptylline
Valproic acid
Botox
What is the main reason prophylactic agents are used?
To prevent progression of episodic migraines to becoming chronic migraines
How does Propanolol relieve migraine symptoms?
Decrease HR and BP, less pounding sensation
What is a disadvantage of using propanolol?
It takes several weeks to show results
What are the common side effects of amytriptylline?
Anticholinergic
What is the main use of Valproic acid?
Anti-seizure
What are the contraindications of Valproic Acid
Pregnancy women in childbearing years
What drug is FDA approved for 2nd line treatment of CHRONIC migraines?
Botox
What is the MOA of Botox
Flaccid paralysis of skull
Is botox effective for episodic migraines?
No
