Migraine Termination

Question 1

Groups used for migraine termination

Answer 1

Serotonin 5-HT 1D/1B receptor agonists

+ Others

Question 2

Serotonin 5-HT 1D/1B receptor agonists names

Answer 2

Dihydroergotamine
Ergotamine
Sumatriptan
Zolmitriptan
Rizatriptan 
Naratriptan

Question 3

Ergot Drugs names

Answer 3

Dihydroergotamine (DHE)

Ergotamine

Question 4

Ergot Drugs M.O.A

Answer 4

Ergot Drugs M.O.A

Question 5

Ergot Drugs administration

Answer 5

Ergotamine

• Parental
• Oral - Poor O.A
• Rectal - Patients with nausea and vomiting

DHE

• Intranasal - moderate onset
• Injectable - rapid onset
  
  • I.M, I.V, S.C
  • Gived with antiemetic(metoclopramide)

Question 6

Ergot drugs adverse effects

Answer 6

Mild
Nausea, Diarrhea, Vomiting, Muscle cramps, cold skin, paresthesia, vertigo

Severe = high doses
Cerebral vasoconstriction, ischemia, rebound vasodilation and headache

Question 7

Ergot drugs contraindications

Answer 7

Coronary artery disease

Pheripheral vascular disease

Question 8

Ergot drugs interactions

Answer 8

Should not be used with B-adrenoreceptor antagonists -> Severe peripheral ischemia

Question 9

Triptan drugs names

Answer 9

Sumatriptan

Zolmitriptan
Rizatriptan
Naratriptan

Frovatriptan
Almotriptan
Eletriptan

Question 10

Triptan drugs M.O.A

Answer 10

Same as Ergotamine

Activates serotonin 5-HT 1D/1B receptor.

Question 11

Triptan drugs administration

Answer 11

Suma - S.C - Most rapid 1 hour
          - Oral - Less rapid 2 hours 
          -  Intranasal
Nara, Riza, Zolmi
          - Limited oral adm
Newer triptans
          - Increased O.A

Question 12

Headache recurrence (Suma vs Newer)

Answer 12

Suma = 40 %

Newer Triptans = 30%

Question 13

Triptan drugs adverse effects

Answer 13

Chest tightness
Weakness
Somnolence (=sleepiness or drowsiness)
Dizziness 
Occurs in 50 %
Paresthesia

Question 14

Triptan drugs contraindications

Answer 14

Angina pectoris
M.I
Other CAD
(Because triptans can cause coronary vasospasm)

Uncontrolled hypertension
(Because triptans can increase BP)

Question 15

Triptan drugs interactions

Answer 15

MAOIs
(Not used concurrently)
Ergot Alkaloids
Methysergide
(Not be used within 24 hours of adm)
SSRI antidepressants
(increased risk of serotonin syndrome)

Question 16

Other drugs for migraine termination

Answer 16

Naproxen
-> Combo with actaminophen, bulbital & caffein

Isometheptene
-> Combo with acetaminophen and mild sedative

Butorphanol
-> Nasal spray - rapid onset

Acetaminophen with Codeine
-> Patients resistant to other treatments

Prochlorperazine
-> Aborting unremitting migrains - I.V