Migraine Nguyen Flashcards
What age range are migraine patients?
18-50 years
Which gender is more affected by migraines?
Women
What are the criteria for migraine diagnosis?
2 of these: unilateral pain, throbbing pain, pain worsened by movement, moderate or severe pain
1 of these: N/V, photophobia, phonophobia
What are the phases/stages of a migraine attack?
- Prodrome: mood change, difficulty concentrating, phonophobia, photophobia, food cravings, yawning, fatigue
- Aura
- Headache
- Postdrome: drained, fatigued, aching muscles, slow movements, thinking
What classes of medications are available for abortive migraine therapy?
triptans, ergot alkaloids, analgesics, combo products, antiemetics
Which triptans are available as nasal spray? What is the benefit of a nasal spray?
Sumatriptan, Zolmitriptan
Benefit: faster acting
Which triptans are available as nasal spray? What is the benefit of a nasal spray?
Sumatriptan, Zolmitriptan
Benefit: faster acting
Which triptans are available as injection? What is the benefit of injection?
Sumatriptan (Imitrex)
Benefit: fast
Why might oral absorption be compromised in some migraine patients? (2)
Poor absorption secondary to migraine-induced gastric stasis
N/V induced by migraine
Sumatriptan is available in what formulations?
injectable, nasal spray, oral
Which triptan has fastest onset?
sumatriptan injectable or nasal
Which triptan is the most long acting? 2nd longest acting?
Frovatriptan, Naratriptan
Why are triptans preferred over ergots?
Ergots give extreme N/V and risk of severe ADE pulmonary fibrosis, better tolerated than ergots
Counsel a patient on how to take a triptan
Tell them to keep a diary
Early treatment within 20-30 min of HA onset
cardiovascular precaution and serotonin syndrome
too much => make headache worse
Counsel a patient on the serious side effects of triptans
Cardiovascular precaution and serotonin syndrome
Which analgesics are recommended as migraine abortive therapy?
Ibuprofen, Naproxen, APAP
Are opioids recommended as migraine abortive therapy?
No
Are butalbital containing treatments recommended as migraine abortive therapy?
No
What agents are used as abortive migraine therapies in emergency department settings?
IV metoclopramide
IV prochlorperazine + IV dephenhydramine
Which of the following are recommended for abortive migraine treatment?
These: triptans, ergot alkaloids, analgesics, combo products, antiemetics
NOT: opioids, fiorinal & fioricet butalbital-containing products
When would you start preventive migraine therapy? List 3 scenarios
- > 4 month
- Longer than 12 hours
- Not frequent, but when it happens, it’s bad.
What are the 5 main medication classes that may be used in preventive migraine therapy?
Anticonvulsants, antidepressants
b blockers, calcium channel antagonists
List 2 examples of AEDs used in migraine patients
valproate
topiramate
List 2 examples of TCAs used in migraine PX
amitriptyline/nortriptyline
SNRI/SSRI
List 2 examples of B blockers used in migraine PX
propranolol, metoproloo, atenolol, timolo, nadolol
Which preventive migraine therapy would be avoided in a patient with severe asthma and why?
Beta blockers
Which preventive migraine therapy(s) would be avoided in patient with severe bradycardia?
beta blocker
Which preventive migraine therapy would be avoided in a patient with prior history of kidney stones?
AEDs
Which preventive migraine therapy would be avoided in a patient who is severely obese?
AEDs, TCAs
Which medications are FDA approved for migraine? (4)
valproate, topiramate, propranolol, timolol
Which class of preventive migraine therapy would be best in a patient with hypertension?
Beta blocker
Which class of preventive migraine therapy would you use in a patient with depression?
TCAs
Which class of preventive migraine therapy would you use in a patient with insomnia?
TCAs
Which preventive migraine therapy would you use in an overweight patient?
idk
Which class of preventive migraine therapy would you use in a patient with epilepsy?
AEDs
