Migraine Headaches

Question 1

Analgesics used to treat migraine?

Answer 1

ASA
APAP
Ibuprofen
Naproxen
\+/- Caffeine

Question 2

Anti-emetic agents

Answer 2

Dopamine receptor antagonists

Question 3

Dopamine receptor antagonists

Answer 3

Metocloproamide

Prochlorperazine

Question 4

Effects of DA receptor antagonists

Answer 4

Relieve N/V

Increase GI motility

Question 5

Problem with administering DA receptor antagonists

Answer 5

Decreased gastric emptying means that parenteral route may be needed

Question 6

MOA of Metoclopramide

Answer 6

D2 Receptor antagonist

Muscarinic receptor stimulator

Question 7

Blackbox warning of Metoclopromide

Answer 7

Tardive dyskinesia (Parkinsonian symptoms) due to decreased DA

Question 8

Which DA receptor antagonist only has effect at the D2 receptor?

Answer 8

Prochlorperazine

Question 9

Which DA receptor antagonist does not have persistalsis activity?

Answer 9

Prochlorperazine

Question 10

Use of Prochlorperazine

Answer 10

Alternative to Metoclorpramide

Question 11

Which drugs are the migraine specific 5-HT1 agonists?

Answer 11

Triptans and Ergot alkaloids

Question 12

What is the mechanism of action of Triptans?

Answer 12

5HT1 receptor agonist selective for 1B and 1D (vasoconstriction, block release of CGRP)

Question 13

What are the effects of triptans?

Answer 13

relieve pain, reduce N/V, increase GI motility

Question 14

Which migraine specific meds are not good for migraines with aura?

Answer 14

triptans

Question 15

Why do you need to use NSAID adjuncts with Triptans?

Answer 15

Triptans have a short half life and usually do not last long enough to cover the headache

Question 16

Contraindication of Triptans?

Answer 16

CAD - vasospasm (angina)

MAOIs (serotonin syndrome - 5HT1 agonist)

Question 17

Why should Triptans not be given by IV?

Answer 17

Because they cause vasospasm (angina)

Question 18

Which drug is the first line for ACUTE migraine?

Answer 18

Sumatriptan

Question 19

Which drug is used as prophylaxis for menstrual migraines?

Answer 19

Frovatriptan

Question 20

which triptan has a long half life of 26 hours?

Answer 20

Frovatriptan

Question 21

Which drugs are used as an alternative to triptans?

Answer 21

Ergot alkaloids (Dihydroergotamine)

Question 22

What is the main side effect of Ergot Alkaloids?

Answer 22

Ergotism - intense vasoconstriction of coronary arteries and peripheral arteries, angina, gangrene

Question 23

What is the main Ergot Alkaloid used?

Answer 23

Dihydroergotamine

Question 24

What is the MOA of Dihydroergotamine?

Answer 24

Non-specific agonist, partial agonist and antagonist on 5HT-1, A-adrenergic, DA receptors

Question 25

What patients should avoid Dihydroergotamine because of higher risk of Ergotism?

Answer 25

Patients on CYP34A inhibitors

Question 26

What are the prophylactic agents used for migraine?

Answer 26

Propanolol Amitriptylline Valproic acid Botox

Question 27

What is the main reason prophylactic agents are used?

Answer 27

To prevent progression of episodic migraines to becoming chronic migraines

Question 28

How does Propanolol relieve migraine symptoms?

Answer 28

Decrease HR and BP, less pounding sensation

Question 29

What is a disadvantage of using propanolol?

Answer 29

It takes several weeks to show results

Question 30

What are the common side effects of amytriptylline?

Answer 30

Anticholinergic

Question 31

What is the main use of Valproic acid?

Answer 31

Anti-seizure

Question 32

What are the contraindications of Valproic Acid

Answer 32

Pregnancy women in childbearing years

Question 33

What drug is FDA approved for 2nd line treatment of CHRONIC migraines?

Answer 33

Botox

Question 34

What is the MOA of Botox

Answer 34

Flaccid paralysis of skull

Question 35

Is botox effective for episodic migraines?

Answer 35

No