Migraine Meds Flashcards
Which serotonin receptors vasodilate?
• Serotonin 2 (5 HT-2) . Low levels
Which serotonin receptors mediate vasoconstriction?
• Serotonin 1 (5 HT-1) . High levels
Propranolol/ Inderal
prophylaxis
Class: Non-selective Beta blocker
• Indication: Hypertension, angina, AMI,
panic attacks and migraine headache • MOA: Blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release.
• Char: P.O., 10 to 100 mg per day. Non- selective beta blockade with potential for bronchoconstriction via antagonism of Beta 2 receptors in bronchi.
Propranolol/ Inderal SE
• Side effects: Bronchoconstriction, hypotension, bradycardia, fatigue, impotence. Abrupt discontinuation may cause rebound hypertension and tachycardia with subsequent increase in myocardial oxygen demand. Abrupt discontinuation increases the risk of arrythmias, stroke, angina and M.I.
Amitriptyline/ Elavil
Prophylaxis
• Class: Tricyclic antidepressant (TCA) • Indication: migraine/ tension headache, chronic pain, bipolar disorder and depression. • MOA: CNS modulation of both serotonin and norepinephrine. • Char: PO and IM. Usually taken at bedtime to minimize side effects of drowsiness and dizziness.
Amitriptyline/ Elavil SE
• Side effects: Dizziness and marked drowsiness. Anticholinergic effects such as dry mouth, constipation, urinary hesitancy and blurred vision. Do not use with monoamine oxidase (MAO) inhibitors. The full benefits of Amitriptyline may take days to several weeks to be observed whereas side effects are usually noted within first several days.
Topiramate/ Topamax
Prophylaxis
• Class: Anticonvulsant
• Indication: Anticonvulsant approved for
use in treating epilepsy and prophylaxis of migraine headaches. Off-label use for bipolar disorder.
• MOA: Block voltage-dependent sodium channels in the CNS, augmenting the activity of the neurotransmitter gamma- amino butyrate (GABA) at some subtypes of the GABA-A receptor. MOA as a migraine medication is not fully known.
Char: PO tablets. Also available in capsules which are designed to be opened to deliver in a sprinkle form for pediatric patients.
**also for weight loss/seizures
Topiramate/ Topamax SE
• Side effects; Fatigue, dizziness, vision changes, acute angle glaucoma, nausea and constipation.
Migraine prophylaxis
• Beta blockers:
Propanolol/ Inderal
Metopralol/ Lopressor
• Calcium channel blockers
Verapamil/ Isoptin
• Tricyclic antidepressants
Amitriptyline/ Elavil
Nortyptylene/ Aventyl
• Ergotamines
Methysergide/ Sansert
Dihydroergotamine/ Migranal
• Anti-seizure medications
Gabapentin/ Neurontin Valproic acid/ Depakote Topiramate/ Topamax
Methysergide/ Sansert
Prophylaxis
• Class: Ergot derivative – serotonin 2 receptor antagonist.
• Indication: Prophylaxis of migraine and cluster headache
• MOA: MOA not fully known, yet it appears to be a Serotonin 2 receptor antagonist which results in vasoconstrictor effect.
Char: PO. Should never be used beyond ~6 months without a drug free interval. Dosage must be tapered to avoid rebound. Do not use within 24 hrs of a triptan because of increased risk of vasoconstrictive spasm.
Ergotism
pathological syndromes affecting humans or animals that have ingested plant material containing ergot alkaloid, such as ergot- contaminated grains.
The common name for ergotism is “St. Anthony’s Fire”,
symptoms: severe burning sensations in the limbs, sometimes leading to gangrene and loss of limbs due to severely restricted blood circulation.
These are caused by effects of ergot alkaloids on the vascular system due to vasoconstriction of blood vessels,
Methysergide/ Sansert
• Side effects: Multiple potential side effects make methysergide a less attractive choice then newer treatment options.
These side effects include but are not limited to hypertension, thrombophlebitis, nausea and vomiting. Pulmonary fibrosis and retroperitoneal fibrosis are severe and potentially life threatening occurrences.

Side effects: Heart valve thickening has also been reported.
Contraindicated in pregnancy (Category X) and in patients with peripheral vascular disease.
• Methysergide is usually reserved for cases refractive to other medications and treatment modalities.
Prodromal phase medications
• Triptans Sumatriptan /Imitrex Zolmitriptan /Zomig Eletriptan /Relpax Naratriptan / Amerge Rizatriptan /Maxalt Frovatriptan/Frova Almotriptan /Axert
Sumatriptan/ Imitrex
Prodromal
• Class: Serotonin agonist
• Indication: Migraine and cluster headache
• MOA: Serotonin agonist at 5-HT 1D and
1B receptors, found in small, peripheral nerves that innervate the intracranial vasculature.
• Char: PO/SQ/Nasal spray. Effectively aborts or markedly reduces the severity of migraines in majority of migraine patients. Onset of action between 10 and 60 minutes. Maximum of 2 doses in 24 hours!!!
Sumatriptan is structurally similar to serotonin (5HT), and is a 5-HT (types 5-HT1D and 5-HT1B agonist. The specific receptor subtypes it activates are present on the cranial arteries and veins. Acting as an agonist at these receptors, Sumatriptan reduces the vascular inflammation associated with migraine.
Sumatriptan/ Imitrex SE
- Side effects: Dizziness, tingling, facial flushing, weakness, chest tightness or pain, arrythmias and hypertension. Use with caution in patients with high blood pressure and in patients with angina.
- Category C in that no adequate and well controlled studies have been done in humans but should be used cautiously, if at all, during pregnancy.
others in this cat:Zomig, Amerge, Maxalt
