Migraine 🤕(Shelby🐈)

Question 1

What does Botox have to do with migraines

Answer 1

it can be used as migraine prophylaxis 💉

… does this mean my insurance will cover it???

Question 2

Which is specific for 5HT1D, triptans or ergots

Answer 2

triptans!!!!

ergots 5HT only

Question 3

Which migraine medication vasoconstricts the arteries of the brain (specifically)

Answer 3

Triptans

Question 4

The treatment of acute migraines utilizes medications that do what

Answer 4

VASOCONSTRICT 🐍🐍🐍🐍🐍🐍🐍🐍🐍🐍🐍

DO NOT F THIS UP

Question 5

What was the crazy story he told about in the lecture with st anthony and everyone’s limbs falling off and what did it have to do with migraine medicine

Answer 5

ergots

they make your limbs falls off if taken chronically due to the VASOCONSTRICTION 🐍☠️

Question 6

Which seizure medications can be used for prophylactic treatment of migraines 🤯

Answer 6

Valproic Acid (Depakene)
Topiramate (Topomax)

Question 7

a 35 year old female presents with acute abdominal pain, bloody diarrhea, cramping, dizziness, and lightheadedness. You have a whole list of GI things on your ddx, you think maybe ectopic pregnancy because you are thinking outside of the box, but you learned in PA school to always have “medication reaction” on your ddx. You ask her if she has started any new medications recently and she tells you “YES omg HOW did you KNOW???” and you are very smart so you ask her, “do you happen to get migraines?” and she’s like “holy shit are you a PA or a fkn psychic???”

What drug do you know she is on

Answer 7

Triptans! 💩💩

maybe ergots but probably not because NOBODY USES THOSE

Question 8

Which analgesics are used to treat the pain in migraine?

Which are specifically NOT used to treat the pain in migraine?

Answer 8

Aspirin, Acetaminophen, Naproxen

Not opioids

Question 10

Which antidepressants can be used for prophylactic treatment of migraines

Answer 10

Amitriptyline (Elavil, Endep)

Fluoxetine (Prozac)

Question 11

which migraine medication is similar to Ergotamine but may have less side effects

Answer 11

Dihydroegotamine (Migranal)

Question 12

What are the two IgG2 monoclonal antibody binds to calcitonin gene-related peptide (CGRP) that can be used for prophylactic treatment of migraines

Answer 12

Erenumab (Aimovig)

Galcanezumab (Emhgality)

Question 13

Which produces MORE vasoconstriction, triptans or ergots?

Answer 13

ergots produce more vasoconstriction than triptans 🐍🐍🐍🐍🐍🐍🐍

less specific 5HT receptor AND is ALSO an alpha 1 agonist which produces even MORE vasoconstriction

Question 14

Which calcium channel blocker can be used for prophylactic treatment of migraines

Answer 14

Verapamil (Calan, Isoptin)

Question 15

What are the contraindications for triptans

Answer 15

if you have anything where vasoconstriction would be a problem 🚫🐍

Breast-feeding, cardiac disease, cerebrovascular disease, coronary artery disease, diabetes, hypertension, intravenous administration, peripheral vascular disease, pregnancy, renal impairment, seizures, smoker

Question 16

Ergot MOA

Answer 16

5HT receptor agonists and alpha 1 agonists

not specific for 5HT1D like triptans

Question 16

How many prophylactic agents for migraines can you name?

Answer 16

Beta-Blockers
Calcium Channel Blockers
Antidepressants 
Clonidine (Catapress)
Valproic Acid (Depakene)
Topiramate (Topomax)
Botulinum Toxin 
Angiotensin II Receptor Blockers (ARBs)
Erenumab (Aimovig) 
Galcanezumab (Emhgality)

Question 17

What are the side effects of Triptans

Answer 17

General vasoconstriction which produces detrimental effects systemically***** 🐍🐍🐍

Cardiovascular issues, arrhythmias, stroke, seizures, cerebrovascular issues, peripheral vascular ischemia, bowel ischemia, abdominal pain, bloody diarrhea, cramping, dizziness, lightheadedness, weakness, myalgia, muscle cramps

Question 18

A 55 year old female comes in to your office and she tells you that she can’t feel her feet anymore. You immediately want to call the toe bro, but you think you can handle it. You put diabetes at the top of your list because why wouldn’t you. You do a fingerstick glucose and it’s normal. You get a whole diabetes work-up and it’s all normal. You take a look at her feet and they are NECROSED. 👣☠️ The smell of dead feet wafts over you and you realize this lady might have a history of migraines. 👃🏽🤢

How do you know this?

Answer 18

She has chronic ergotism

She took ergots for like 40 years for her migraines

vasoconstriction to the limbs 🐍🐍🐍

dead fucking feet ☠️👣

Question 19

You have a 29 year old female come into your office complaining of anxiety, depression, and migraines.

How do you kill all 3 birds with one stone 🐦🐦🐦

Answer 19

Fluoxetine (Prozac)

used for migraine PROPHYLAXIS

Question 20

If someone is on an ergot for migraines for like 30 years, what is a possible side effect?

Answer 20

Chronic ergotism: vasoconstriction leading to GANGRENE ☠️

Question 21

Triptan MOA

Answer 21

5-HT 1D receptor agonist on small peripheral nerves

Vasoconstriction 🐍 of the arteries in the brain 🧠(specific)

Question 21

Which beta blocker can be used for prophylactic treatment of migraines

Answer 21

Propranolol (Inderal)

Question 23

Which medications that are traditionally used in heart problems can be used as prophylactic agents for migraines ❤️❤️❤️❤️

Answer 23

❤️Beta-Blockers
❤️Calcium Channel Blockers
❤️Clonidine (Catapress)
❤️Angiotensin II Receptor Blockers (ARBs)