Migraine Tx Flashcards
What is a migraine?
Common episodic disorder that presents as a disabling headache - generally associated with nausea, and/or light and sound sensitivity. Treatment for migraines usually consist of drugs for acute tx of migraines as well as prevention of migraine.
What medications are used for mild to moderate migraine attacks?
Acetaminophen and NSAIDs
*These medications are used for mild to moderate attacks, not associated with vomiting or severe nausea.
Triptans?
Triptans are the drug of choice for moderate to severe migraines as they are selective agonists at 5-HT1D and 5-HT1B receptors. Combination of SUMATRIPTAN and NAPROXEN provides better relief than either drug alone. Subcutaneous sumatriptan is the fastest-acting and most effective triptan formulation.
What are the adverse effects of Triptans?
Tingling, flushing, dizziness, fatigue, chest tightness
Rare - angina, MI, arrhythmia, stroke, death
Contraindicated in coronary, cerebrovascular or other arterial disease or uncontrolled HTN
**these drugs are vasoconstrictors
Ergot Alkaloids: Ergotamine and Dihydroergotamine?
These are drugs used for moderate to severe migraine attacks. Ergotamine acts as an agonist at the a-adrenoceptors, 5-HT, and D2 receptors. The agonist activity at 5-HT1B/1D receptor is most likely what mediates the anti-migraine effects by preventing vasodilation.
What are the adverse effects of Ergot alkaloids?
Nausea and vomiting - which can be prevented with antiemetic such as metoclopramide
Rare serious effects: vascular occlusion and gangrene [usually associated with overdosage]
Dihydroergotamine is a weaker vasoconstrictor compared to ergotamine therefore has fewer AE.
**do not use in pts with arterial disease or uncontrolled HTN
What first line drugs are used in the prevention of migraines?
- B-blockers
- Valproate
- Topiramate
What are the second or third line drugs to prevent migraines?
- tricyclic antidepresants
- SNRIs
- Ca2+ channel blockers
- Gapapentin
- ACEIs or ARBs
- Botulinum toxin
- NSAIDs
B blockers in prevention of migraines?
Propranolol, Timolol, Metoprolol, Nadolol, Atenolol
*For continuous prophylaxis
Valproate with migraines?
Valproate is indicated for bipolar disorder, epilepsy and migraine prophylaxis. It functions by inhibiting VG Na+ channels and T-type Ca2+ channels
AE - GI side effects, thrombocytopenia, hepatotoxicity (rare), teratogenic
Topiramate with migraines?
Topiramate is indicated for epilepsy and migraine prophylaxis. It inhibits VG-Na+ channels, acts as a GABAa receptor agonist and glutamate receptor antagonist.
AE - somnolence, fatigue, cognitive slowing, nervousness, confusion, acute myopia, glaucoma, hyperthermia, renal stones, teratogenic [CNS AE are the most common]
Which tricyclic antidepressants can be used to prevent migraines?
Amitriptyline
Nortriptyline
Imipramine
*TCAs inhibit NE and serotonin reuptake
AE - sedation, dry mouth, weight gain
Venlafaxine with migraines?
Venlafaxine is a serotinin norepinephrine reuptake inhibitor (SNRI) that is used as a second or third line agent to prevent migrains.
AE - nausea, constipation, insomnia, headaches, sexual dysfunction
Ca2+ channel blockers in prevention of migraines?
Verapamil is used as a second or third line agent in the prevention of migraines. Although it prevents them, the evidence for their effectiveness is weak. Verapamil has the most evidence of efficacy of all CCBs.
Gabapentin with migraines?
Gabapentin is used as a second or third line agent to prevent migraines. It decreases glutamate release by blocking presynaptic VG Ca2+ channels.
AE - sleepiness, dizziness, fatigue
