Migraines

Question 1

How are migraines diagnosed?

Answer 1

Two features must occur:
unilateral head pain
throbbing pain
worsens with activity
moderate / severe pain

And one of:
N/V
Photophobia
Phonophobia (avoidance of sound)

Question 2

What are the 3 classifications of migraines?

Answer 2

1. Aura present
2. Aura not present
3. Chronic

Question 3

What classifies a chronic migrane?

Answer 3

15 days out of the month for 3 months.

Question 4

What are the risk factors for migranes?

Answer 4

Family hx
Estrogen and progesterone
Genetic and environmental factors

Question 5

How do estrogen and progesterone change during menstruation, menopause, and pregnancy?

Answer 5

Menses = increase
Menopause = decrease
Pregnancy = decrease

Question 6

What are the triggers of migraines?

Answer 6

Fatigue
Oversleeping
Missed meals
Overexertion
Weather changes
Stress
Hormonal stress
Bright lights / strong smells

Question 7

What is the patho behind migraines?

Answer 7

Not very sure
There is a potential change in neurotransmitter levels (excitatory neurotransmitters triggering vasodilation) and vessel tone

Question 8

What are the clinical phases of migraines?

Answer 8

1. Premonitory phase
2. Migraine aura
3. Headache phase
4. Recovery phase

Question 9

What happens in the premonitory phase of migraines?

Answer 9

Common to have fatigue, irritability, loss of concentration, stiff neck, and/or food cravings.

Question 10

What happens in the migraine aura of migraines?

Answer 10

Common to have visual, sensory, or motor auras. These can last up to an hour.

Question 11

What happens in the headache phase of migraines?

Answer 11

Throbbing pain on one side of the head that later spreads to the entire head
Fatigue, N/V, dizziness, hypersensitivity to touch on head
Can last 4 - 72 hours

Question 12

What happens in the recovery phase of migranes?

Answer 12

Irritability, fatigue, depression

Question 13

What medications are used as abortive agents for migraines?

Answer 13

Aspirin like drugs (ASA, acetaminophen, NSAIDs)
Serotonin receptor agonists (sumatriptan)
Calcitonin gene-related peptide antagonist

Can add antiemetic agent if nausea is present

Question 14

What class of drugs is sumatriptan?

Answer 14

Serotonin receptor agonist

Question 15

What is the MOA of sumatriptan?

Answer 15

Constricts intracranial blood vessels
Suppresses release of inflammatory neuropeptides
Block brain pathways for pain

Question 16

What are the side effects of sumatriptan?

Answer 16

Injection site reaction, chest pressure, flushing, weakness, headache, bad taste (when done intranasally)

Question 17

What routes is sumatriptan available in?

Answer 17

SQ. PO, intranasal

Question 18

What are contraindications with sumatriptan?

Answer 18

Ischemic stroke, heart disease, and angina

Question 19

What type of route has more side effects with sumatriptan?

Answer 19

SQ

Question 20

What class of medication is Rimegepant?

Answer 20

Calcitonin gene-related peptide antagonist

Question 21

What is the MOA of rimegepant?

Answer 21

Mediates pain transmission

Question 22

What is the indication for rimegapant?

Answer 22

Migraines - when patient cannot take triptans

Question 23

What are the side effects of rimegapant?

Answer 23

GI upset (N/V, dyspepsia)

Question 24

What are the nursing considerations for rimegapant?

Answer 24

PO
CYP substrate

Question 25

Who is preventative therapy for with migraines?

Answer 25

For patients that have 4+ migraines a month or migraines that last longer than 12 hours

Question 26

What medications are used for preventative therapy?

Answer 26

Beta-blockers (propranolol)
Tricyclic antidepressants (amitriptyline)
Antiepileptic drugs (divalproex, topiramate)
Estrogen (for menstrual migraines)