Migraines Flashcards
what is a migraine
episodic neurologic disorder characterized by h/a that lasts from 4-72 hours
how is a migraine diagnosised
two features:
- unilateral headache
- throbbing pain
- worsens with activity
- moderate/severe pain
one of these
- N/V
- photophobia (light)
- phonophobia (sound)
what are the classifications of migraines
aura
aura not present
chronic: 15 days per month for 3 months
what is aura
visual, sensory, motor symptoms
what are the risk factors for migraines
fam hx
estrogen or progesterone (menstrating, pregnancy, menopause)
genetic and env factors
what are the triggers of migraines
fatigue
oversleeping
missed meals
over exertion
weather changes
stress
hormonal changes
bright light or strong smells
what is the pathology of migraines
complex and not fully understood
- there are a change in neurotransmitter levels in CNS that inc depolarization resulting in hyperactivity
- blood vessel tones –> inc excitatory NT activates vaso DILATION
what are the clinical phases of migraines
premonitory phase
migraine aura
headache phase
recovery phase
what happens in the premonitoring phase
1/3 have fatigue, irritability, loss of concentration, stiff neck and food cravings
what happens during the aura phase of migraines
up to 1/3 have aura sx lasting up to an hour
what happens during the headache phase
throbbing pain
fatigue, N, V, dizziness, hypersensitivity to touch on head
lasts 4 to 72 hours
what happens during the recovery phase
irritability, fatigue, depression
what are the broad therapy drugs used for migraines
aspirin like
serotonin receptor agonists
calcitonin gene related peptide
what class is sumatriptan
serotonin receptor agonist
what is the moa of sumatriptan
vasoconstricts intercrainal blood vessels
suppress release of inflammatory neuropeptides
block bran pathway for pain
what is the route for sumatriptan
sub q
PO
intranasal
what are the side effects of sumatriptan
SQ: injection site rxn, chest pressure, flushing, weakness
headache, bad taste
what are considerations for sumatriptan
ischemic stroke
heart disease
angina
what class is rimegepant
CGRP antagonist
what is the moa of rimegepant
mediates pain transmission
what is the route for rimegepant
PO
what are the se of rimegepant
GI upset
what are the considerations for rimegepant
CYP sustrate
what is preventative therapy for migraines
for migraines more than 4 months, lasts longer than 4 hours, chronic
beta blockers (propranolol)
TCAs
anti epileptic (divalproex, topiramate)
estrogen (menstrual migraines)
