migraines

Question 1

to be diagnosed with migraines you must have 2 of the following

Answer 1

unilateral head pain
throbbing pain
worsening pain with activity
moderate/severe pain

Question 2

to be diagnosed with migraines you must have 1 of the following

Answer 2

n/v
photophobia
phonophobia

Question 3

3 classifications of migraines

Answer 3

aura present
aura not present
chronic (15 days per month for 3 months)

Question 4

to be diagnosed with chronic migraines what is the time frame

Answer 4

15 episodes per month for 3 months

Question 5

risk factors for migraines

Answer 5

fam hx
estrogen/ progesterone
genetic/environmental factors

Question 6

migraine triggers

Answer 6

fatigue
oversleeping
missed meals
overexertion 
weather changes
stress
hormonal changes
bright lights
strong smells

Question 7

pathophysiology of migraines

Answer 7

change in neurotransmitters in CNS, change in blood vessel tone

Question 8

4 clinical phases of migraines

Answer 8

premonitory
migraine aura
headache phase
recovery phase

Question 9

premonitory phase of migraine

Answer 9

1/3 have fatigue, irritability, loss of concentration, stiff neck, food cravings

Question 10

migraine aura

Answer 10

up to 1/3 have aura symptoms lasting up to 1 hour prior

Question 11

headache phase of migraine

Answer 11

throbbing pain
fatigue, nausea, vomiting, dizziness
hypersensitivity to touch on head
lasts 4 to 72 hours

Question 12

recovery phase

Answer 12

irritability, fatigue, depression

Question 13

abortive (symptomatic) therapy

Answer 13

asa like drugs (asa, acetaminphen, NSAIDS)
serotonin 1B/1D receptor agonists (triptans, sumatriptan)
calcitonin Gene-related peptide (CGRP) antagonist

Question 14

Sumatriptan

Answer 14

serotonin 1B/1D receptor agonist

Question 15

MOA sumatriptan

Answer 15

constrict intracranial blood vessels
suppress release of inflammatory neuropeptides
block brain pathways for pain

Question 16

sumatriptan route of admin

Answer 16

PO, Sub-q, intranasal

Question 17

side effects of sumariptan

Answer 17

injection site redness, chest pressure, flushing, weakness, headache, bad taste (nasal)

Question 18

when do you avoid sumatriptan?

Answer 18

ischemic stroke
heart disease
angina

Question 19

rimegepant

Answer 19

CGRP antagonist

Question 20

rimegepant MOA

Answer 20

mediates pain transmission

Question 21

rimegepant route

Answer 21

PO

Question 22

rimegepant side effects

Answer 22

GI upset

Question 23

considerations before giving rimegepant

Answer 23

CYP substrate give cautiously with other CYP drugs

Question 24

migraine preventative therapy

Answer 24

beta blockers- propranolol
tricyclic antidepressants
antiepileptic drugs ( divalproex, topiramate)
estrogens ( for menstrual migraines)

Question 25

preventative therapy goals of migraines

Answer 25

reduce frequency, severity, and duration
improve responsiveness of tx to acute attacks
improve function and reduce disability
prevent progression from acute to chronic