migraines Flashcards
what drives migraines
cortical spreading depression
what entails a cortical spreading depression
a wave of depolarization followed by desensitization
what is the genetic contribution to migraines
familial hemiplegic migraines
what are the 3 known genetic mutation associated with familial hemiplegic migraines
P/Q type calcium channels
Na / K ATPase
Na channel subunit
what is the largest cranial nerve
trigeminal nerve
What are the 3 main branches of peripheral processes
opthalmic maxilliary and mandibular
what are the 3 purposes of the trigeminal nerve
senses pain and temperature in the head region
innervated the dura matter
controls cerebral blood vessels (trigeminovascular system)
how does serotonin affect migraines
vasoconstriction
what is CGRP
calcitonin gene-related peptide
describe CGRP levels in those with migraine
elevated
what is propanol
beta blocker, decrease blood pressure, prophylactic
what is gabapentin
anticonvulsant, blocks pain transmission, prophylactic
what is amitriptyline
antidepressant, seratonin reuptake inhibitor by blocking SERT, prophylactic
where does caffeine act
adenosine receptor antagonist
what ergot alkaloid
agonist 5HT-1b/d that inhibits neurogenic inflammation
what is the downfall of ergot alkaloid
low degree of receptor selectivity
coronary vasoconstriction
what is the half life of ergotamines
2 hours
how are ergotamines excreted
bile
what is bioavailability of ergotamines
1%
what is a triptan
selective 5-HTb/d agonist
what are the 2 mechanisms of triptans
vasoconstriction
inhibition of the trigeminal nerve
what is the bioavailability of triptan (orally and subcutaneously)
14% orally, 96% subcutaneously
how is triptan excreted?
urine
what are CGRP antagonists
treatment under development
why was olcegepant (BIBN4096) abandoned
poor bioavailability abandoned at phase II
why was MK-0974 (Telcagepant) abandoned
elevation of aminotransferase abandoned at phase III
what is rimegepant (nurtek)
effective miigraine treatment
