Migraine Treatment Flashcards
Whatis the neurovascular theory of Migraines?
Neurovascular theory is one that states, migraines are caused: because of vasodilation in the arteries surrounding the trigeminal nerve. When the trigeinal nerve is irritated, it releases inflammatory ediator such as Substance P and CGRP, which cause further inflammation of the meninges, further vaodilation, and pain.
Describe migraine symptoms.
Throbbing pain on one side of head, usually occurs before an aura.. can be accompanied by photophobia, phonophobia, nausea, vomiting, vertigo, etc. More commonn in females.
What are the two serotonin receptor targeted in migraine therapy, and what do these recptors usually do?
5-HT1B (they cause vasocnstriction), and 5-HT1D (which inhibit the release of neuropeptides like substance P and CGRP, and also hence, decrease vasodilation.
What drugs act on the 5-HT1B receptor and what effects dose it have?
Triptans (sumatriptan), this effectively reduces vasodilation in the brain, heart, and blood vessels.Never give triptans to patients with a history of Coronary artery disease. These drugs also reduce the vomiting and nausea associatedwith migraines.
What migraine medication acts as a 5-HT1D agonist?
Ergot alkaloids - dihydroergotamie.
What happens if a patient is on ergot alkaloids for a long time/toxicity?
Longterm use will lead to pericardial , pleural, and retroperintoneal fibrosis. Also, toxic side effects may be hallucinations (salem witch trials), convulsions and gangrene.
When are ergots used for migraine therapy?
With a patient has a history of Coronary artery disease and they annot use triptan = type drugs.
Why don’t you use triptans and ergots together?
Will cause excessive vasoconstriction and lead to CV collapse.
What drugs can be used to prevent migraines?
Betabloker –> propanolol and anti-convulsants –> valproae, divalproex, topiramate; Tricycics: amitriptyline; NSAIDs –> naprxen and ibuprofen, Ca2+ channel blockers –> verapamil, Nerve blockers –> botox
