Migraines Flashcards
What are the two different type of migraines?
- Migraine WITHOUT aura & Migraine WITH aura
What is a migraine WITHOUT aura?
- At least 5 attacks
- Headache lasting 4-72 hours
- Unilateral, Pulsating, moderate pain
- SE: Nausea, Vomiting, Photophobia, Phonophobia
What is a migraine WITH aura?
- Two attacks
- One fully reversible aura
- NO aura lasting 60 mins -> headache within 60 mins
- SE: Visual, Sensory, speech, motor, brainsteam, retinal
What are some of the other migraine types [not WITH or WITHOUT aura]?
- Status Mirgrainosus: Attack lasting > 72 hours
- Basilar-Type Migraine: Bilateral pain in back of the head
- Hemiplegic Migraine: Temporary paralysis on one side of the body
What are the four phases of migraine headache?
- Prodome, Aura, Migraine Headache, Postdromal
What is the Prodrome phase of Migraine headaches?
- Can feel the symptoms of a migraine hours or days BEFORE onset
- SE: Euphoria, Depression, Irritability, Food Craving, Constipation, Neck stiffness, Yawning
What is the Aura phase of Migraine Headaches?
- Most commonly visual [maybe sensory, sensory, motor] issues
- BEFORE or DURING the migraine lasting 60 mins
- SE: Photopsia, Scotoma, Zigzag Lines; Numbness/Tingling in arms, legs, face
What is the Migraine Headache phase of Migraine Headache??
- Dull aches
- Unilateral and throbbing
- SE: Phonophobia and/or photophobia
What is the Postdromal phase of Migraine headaches?
- Headache like symptoms that last for several days after the headache has ended
- SE: Tiredness, head pain, GI Issues, Weakness, Cognitive Difficultes
What are some of the triggers for Migraines?
- Medication overuse
- Medications: OC, Hydralazine, NTG, Nifedipine…
- Foods: Choclate, oranges, tomatoes, CAFFEINE, alcohol…
- Additives/Presevatives: Aspartame and MSG
- Environment
- Too LITTLE or too MUCH sleep, skipping meals, stress…
How is a migraine caused from medication overuse?
- Its is a rebound headache that result from the body becoming use to using meds to help with the headache
- Associated with analgesics, ergots, triptans
- Treated with low dose NSAID
What are the two type of treatment for migraines?
- Abortive & Preventive
What is Abortive treatment for migraines?
- Acute treatment; ALL patients should be offered
- EDUCATE to avoid overuse
- Mild-Moderate: NSAIDS or Acetaminophen
- Moderate-Severe: Triptans or Ergots
What is Preventive treatment for mirgraines?
- Four or more attacks/months with disability at least 3 days/month
- FAIL abortive treatment or USING abortive meds more than twice a week
- Cheaper than acute meds
What are some of the medications that are used in abortive treatment for migraines?
- 1st Line: Triptans, NSAIDS [Ergots, Butorphanol]
- 2nd Line: NSAIDS [Ergotamines, combo products]
- 3rd Line: Contraindications or Failure to respond use IV Valproate
What are some of the medications that are used in Prevention treatment of Migraines?
- 1st Line: Valproate, Topiramate, Metoprolol, Propranolol [Botox?]
- 2nd Line: Amitriptyline
- 3rd Line: Calcitonin Gene-Realted, Peptide (CGRP) Receptor Antagonist
What are some of the non-pharmacological therapy for migraines?
- Biofeedback and Relaxation Therapy
- Cognitive Behavioral Therapy
- Diet
- Sleep
-Transcutaneous Electrical Nerve Stimulation Device - Exercise, Massage, Acupuncture…
- Headache Diary [Avoid Triggers]
What is the mechanism of action for the Triptans in migraines?
- MOA: Selective Serotonin [5-HT1b and 5-HT1d] Agonist; releaves the migraine by constricting blood vessels
- Increasing serotonin TOO MUCH could cause Serotonin Syndrome [Fatal?]
What are some of the contradictions for Triptans in migraines?
- DO NOT use if an ergot or other triptan or MAO Inhibitor were recently used; heart disease, history of stroke…
What are some of the warnings for using Triptans in migraines?
- Pain in chest, HTN, GI issues, Medication overuse, SEROTONIN SYNDROME; sulfa allergy and corneal apacities [Almotriptan], seizures
What are some of the side effects for triptans in migraines?
- Dizziness, Drowsiness, Nausea, Vomiting, Chest Pain
What are some of the drug interactions for triptans in migraines?
- MAO Inhibitors
- SSRIs/SNRIs: Triptans with SSRIs/SNRIs can INCREASE the risk of SEROTONIN SYNDROME [VERY RARE]
What is the mechanism of action for the Ergot Alkaloids in migraine treatment?
- MOA: It stimulates alpha-adenergic receptors and decreases vascular tone with vasoconstriction; causing vasoconstriction
What are some of the contraindications with the ergot alkaloids in mirgraine?
- Coronary heart disease, STRONG 3A4 inhibitor [drug interation], HTN…
What are some of the side effects for ergot alkaloids in migraines?
- Ergotism [hallucinations], vasoconstricitve complications, ischemia, cold in extremities, Nausea, vomiting
What is the function of the Calcitonin Gene-Ralated Peptide (CGRP) receptor antagonist in abortive treatment for migraine?
- MOA: The activation of the CGRP receptors cause inflammation and pain; blocking this receptor will cause intrecranial vasoconstriction & stop inflammation cytokines
What are the two CGRPs used in migraines?
- Rimegepant & Ubrogepant
What are some of the side effects CGRPs in migraines?
- Rimegepant: NAUSEA, rash, dyspnea
- Ubrogepant: NAUSEA, somnolence, xerosomia
What are some of the drug interactions for CGRPs in migraines?
- Moderate/strong 3A4 inducers and inhibitors & p-glycoprotein inhibitors
What is the function of Lasmiditan in migraine?
- MOA: Serotonin [5-HT1f] Receptor Agonist; causing an increase of serotonin and vasoconstriction = decreasing migraine symptoms
What were the warnings/precautions associated with Lasmiditan in migraine?
- Medication overuse, Sedation, Dizziness, SEROTONIN SYNDROME, Driving impairment
When should Lasmiditan be used in treatment for migraines?
- Last line [After Triptans and NSAIDS] used as abortive treatment
What are some of the other abortive treatment used for migraines?
- Butorpharnol Nasal Spray [Rescue Med: Most Important]
- Aspirin combo, Oral Opioid, Aspirin/Caffeine combo…
What are the medications that are used in abortive treatment for Migraines?
- Triptans [MAIN one used], NSAIDS, Ergot Alkaloids, CGRP [3rd line], Lasmiditan [LAST LINE]
What are the medications that are used in preventive treatment for migraines?
- Beta-Blockers, Amitriptyline, CGRP Antagonists, Valproate, Topiramate, Botox?
What beta-blockers are used in preventive migraine treatment? [FDA Approved][
- Propranolol 80-240 mg/day
- Metoprolol 100-200 mg/day
- SE: Fatigue, bradycardia, bronchospam, depression
- CONTRAINDICTATED: Asthma; Raynauds
What tricyclic antidepressant is used in preventive migraine treatment? [Non-FDA Approved]
- Amitriptyline 25-150 mg/day
- BEDTIME DOSING = sedation
What is the function of the CGRP antagonists in preventive treatment of migraines?
- MOA: Block the CGRP receptors on blood vessels causing vasoconstriction; reducing the migraine symptoms [Erenumab-aooe]
- MOA: Binds the CGRP ligans and prevents binding to the receptors [Atogepant]
- Monoclonal Antibodies
What are some of the side effects for the CGRP antagonists in preventive treatment of migraines?
- Nausea, Constipation, Fatigue [ATOGEPANT]
What are the Antiseizure medications used in the preventive treatment of migraines?
- Valproate 500-1500 mg/day & Topiramate 50-100 mg/day
- NOT RECOMMENDED for child-bearing women
How is botox used in the preventive treatment of migraines?
- MOA: Injected into specific part of the muscles in the head to limit the release of neurotransmitters in the brain
What are some of the miscellaneous preventive treatments for migraines?
- Buterbur/Petasites 150 mg/day [MAIN ONE]
- Cyproheptadine, Magnesium oxide, Riboflavin, Coenzyme q10, Feverfew
What are some of the migraine treatments used in/during pregancy?
- Dihydroergotamine/Ergotamine: CONTRAINDICATED
- Triptans: ONLY is benefits outweigh risks
- CGRP Antagonist: Unknown
- Valproate: CONTRAINDICATED; OC is needed
- Botox: ONLY if benefits outweighs risks
- Topiramate: Fetal harm; metabolic acidosis during or after
