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PHRM 845: Therapeutics III > Migraines > Flashcards

Migraines Flashcards

1
Q

What are the two different type of migraines?

A
  • Migraine WITHOUT aura & Migraine WITH aura
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2
Q

What is a migraine WITHOUT aura?

A
  • At least 5 attacks
  • Headache lasting 4-72 hours
  • Unilateral, Pulsating, moderate pain
  • SE: Nausea, Vomiting, Photophobia, Phonophobia
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3
Q

What is a migraine WITH aura?

A
  • Two attacks
  • One fully reversible aura
  • NO aura lasting 60 mins -> headache within 60 mins
  • SE: Visual, Sensory, speech, motor, brainsteam, retinal
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4
Q

What are some of the other migraine types [not WITH or WITHOUT aura]?

A
  • 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
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5
Q

What are the four phases of migraine headache?

A
  • Prodome, Aura, Migraine Headache, Postdromal
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6
Q

What is the Prodrome phase of Migraine headaches?

A
  • Can feel the symptoms of a migraine hours or days BEFORE onset
  • SE: Euphoria, Depression, Irritability, Food Craving, Constipation, Neck stiffness, Yawning
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7
Q

What is the Aura phase of Migraine Headaches?

A
  • 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
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8
Q

What is the Migraine Headache phase of Migraine Headache??

A
  • Dull aches
  • Unilateral and throbbing
  • SE: Phonophobia and/or photophobia
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9
Q

What is the Postdromal phase of Migraine headaches?

A
  • Headache like symptoms that last for several days after the headache has ended
  • SE: Tiredness, head pain, GI Issues, Weakness, Cognitive Difficultes
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10
Q

What are some of the triggers for Migraines?

A
  • 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…
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11
Q

How is a migraine caused from medication overuse?

A
  • 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
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12
Q

What are the two type of treatment for migraines?

A
  • Abortive & Preventive
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13
Q

What is Abortive treatment for migraines?

A
  • Acute treatment; ALL patients should be offered
  • EDUCATE to avoid overuse
  • Mild-Moderate: NSAIDS or Acetaminophen
  • Moderate-Severe: Triptans or Ergots
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14
Q

What is Preventive treatment for mirgraines?

A
  • 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
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15
Q

What are some of the medications that are used in abortive treatment for migraines?

A
  • 1st Line: Triptans, NSAIDS [Ergots, Butorphanol]
  • 2nd Line: NSAIDS [Ergotamines, combo products]
  • 3rd Line: Contraindications or Failure to respond use IV Valproate
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16
Q

What are some of the medications that are used in Prevention treatment of Migraines?

A
  • 1st Line: Valproate, Topiramate, Metoprolol, Propranolol [Botox?]
  • 2nd Line: Amitriptyline
  • 3rd Line: Calcitonin Gene-Realted, Peptide (CGRP) Receptor Antagonist
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17
Q

What are some of the non-pharmacological therapy for migraines?

A
  • Biofeedback and Relaxation Therapy
  • Cognitive Behavioral Therapy
  • Diet
  • Sleep
    -Transcutaneous Electrical Nerve Stimulation Device
  • Exercise, Massage, Acupuncture…
  • Headache Diary [Avoid Triggers]
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18
Q

What is the mechanism of action for the Triptans in migraines?

A
  • 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?]
19
Q

What are some of the contradictions for Triptans in migraines?

A
  • DO NOT use if an ergot or other triptan or MAO Inhibitor were recently used; heart disease, history of stroke…
20
Q

What are some of the warnings for using Triptans in migraines?

A
  • Pain in chest, HTN, GI issues, Medication overuse, SEROTONIN SYNDROME; sulfa allergy and corneal apacities [Almotriptan], seizures
21
Q

What are some of the side effects for triptans in migraines?

A
  • Dizziness, Drowsiness, Nausea, Vomiting, Chest Pain
22
Q

What are some of the drug interactions for triptans in migraines?

A
  • MAO Inhibitors
  • SSRIs/SNRIs: Triptans with SSRIs/SNRIs can INCREASE the risk of SEROTONIN SYNDROME [VERY RARE]
23
Q

What is the mechanism of action for the Ergot Alkaloids in migraine treatment?

A
  • MOA: It stimulates alpha-adenergic receptors and decreases vascular tone with vasoconstriction; causing vasoconstriction
24
Q

What are some of the contraindications with the ergot alkaloids in mirgraine?

A
  • Coronary heart disease, STRONG 3A4 inhibitor [drug interation], HTN…
25
Q

What are some of the side effects for ergot alkaloids in migraines?

A
  • Ergotism [hallucinations], vasoconstricitve complications, ischemia, cold in extremities, Nausea, vomiting
26
Q

What is the function of the Calcitonin Gene-Ralated Peptide (CGRP) receptor antagonist in abortive treatment for migraine?

A
  • MOA: The activation of the CGRP receptors cause inflammation and pain; blocking this receptor will cause intrecranial vasoconstriction & stop inflammation cytokines
27
Q

What are the two CGRPs used in migraines?

A
  • Rimegepant & Ubrogepant
28
Q

What are some of the side effects CGRPs in migraines?

A
  • Rimegepant: NAUSEA, rash, dyspnea
  • Ubrogepant: NAUSEA, somnolence, xerosomia
29
Q

What are some of the drug interactions for CGRPs in migraines?

A
  • Moderate/strong 3A4 inducers and inhibitors & p-glycoprotein inhibitors
30
Q

What is the function of Lasmiditan in migraine?

A
  • MOA: Serotonin [5-HT1f] Receptor Agonist; causing an increase of serotonin and vasoconstriction = decreasing migraine symptoms
31
Q

What were the warnings/precautions associated with Lasmiditan in migraine?

A
  • Medication overuse, Sedation, Dizziness, SEROTONIN SYNDROME, Driving impairment
32
Q

When should Lasmiditan be used in treatment for migraines?

A
  • Last line [After Triptans and NSAIDS] used as abortive treatment
33
Q

What are some of the other abortive treatment used for migraines?

A
  • Butorpharnol Nasal Spray [Rescue Med: Most Important]
  • Aspirin combo, Oral Opioid, Aspirin/Caffeine combo…
34
Q

What are the medications that are used in abortive treatment for Migraines?

A
  • Triptans [MAIN one used], NSAIDS, Ergot Alkaloids, CGRP [3rd line], Lasmiditan [LAST LINE]
35
Q

What are the medications that are used in preventive treatment for migraines?

A
  • Beta-Blockers, Amitriptyline, CGRP Antagonists, Valproate, Topiramate, Botox?
36
Q

What beta-blockers are used in preventive migraine treatment? [FDA Approved][

A
  • Propranolol 80-240 mg/day
  • Metoprolol 100-200 mg/day
  • SE: Fatigue, bradycardia, bronchospam, depression
  • CONTRAINDICTATED: Asthma; Raynauds
37
Q

What tricyclic antidepressant is used in preventive migraine treatment? [Non-FDA Approved]

A
  • Amitriptyline 25-150 mg/day
  • BEDTIME DOSING = sedation
38
Q

What is the function of the CGRP antagonists in preventive treatment of migraines?

A
  • 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
39
Q

What are some of the side effects for the CGRP antagonists in preventive treatment of migraines?

A
  • Nausea, Constipation, Fatigue [ATOGEPANT]
40
Q

What are the Antiseizure medications used in the preventive treatment of migraines?

A
  • Valproate 500-1500 mg/day & Topiramate 50-100 mg/day
  • NOT RECOMMENDED for child-bearing women
41
Q

How is botox used in the preventive treatment of migraines?

A
  • MOA: Injected into specific part of the muscles in the head to limit the release of neurotransmitters in the brain
42
Q

What are some of the miscellaneous preventive treatments for migraines?

A
  • Buterbur/Petasites 150 mg/day [MAIN ONE]
  • Cyproheptadine, Magnesium oxide, Riboflavin, Coenzyme q10, Feverfew
43
Q

What are some of the migraine treatments used in/during pregancy?

A
  • 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

PHRM 845: Therapeutics III (25 decks)

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