Migraines Flashcards
definition of migraine
headache lasting 4-72 hours
At least two of these features must occur for diagnosis of migraine
–unilateral head pain
–throbbing pain
–worsens with activity
–moderate/severe pain
One of these features must occur for diagnosis of migraine
–N/V
–photophobia
–phonophobia
classifications of migraines
–aura present
–aura not present
–chronic (15 days/month for 3 months)
risk factors for migraines
–family hx
–estrogen and progesterone
–genetic and environmental factors
triggers for migraines
–fatigue
–oversleeping
–missed meals
–overexertion
–weather change
–stress
–hormonal changes
–bright lights or strong smells
patho of migraines
–change in neurotransmitter levels in CNS
–blood vessel tone
–vasodilation
premonitory phase in migraines
1/3 have…
–fatigue
–irritability
–loss of concentration
–stiff neck
–food cravings
migraine aura
up to 1/3 have aura symptoms lasting up to 1 hour
headache phase of migraines
–throbbing pain
–fatigue, nausea, vomiting, dizziness, hypersensitivity to touch on head
–last 4 to 72 hours
recovery phase of migraine
–irritability
–fatigue
–depression
abortive (symptomatic) therapy for migraines
–aspirin-like drugs (ASA, acetaminophen, NSAIDs)
–Serotonin Receptor Agonists (triptans) – sumatriptan
–Calcitonin Gene-related Peptide (CGRP) Antagonist
example of serotonin receptor agonist
sumatriptan
MOA of sumatriptan
–constrict intracranial blood vessels
–suppress release of inflammatory neuropeptides
–block brain pathways for pain
route for sumatriptan
–SQ
–PO
–intranasal
side effects of sumatriptan
–injection site reaction (SQ)
–chest pressure
–flushing
–weakness
–headache
–bad taste (nasal)
how long do side effects of sumatriptan last?
about 30 minutes
considerations for sumatriptan
avoid with ischemic stroke or heart disease and angina
example of CGRP antagonist
rimegepant (Nurtec)
MOA of rimegepant
mediates pain transmission
route for rimegepant
PO
side effects for rimegepant
GI upset
considerations for rimegepant
CYP substrate (caution with inhibitors or inducers)
preventive therapy for migraines
–beta blockers (propanolol)
–tricyclic antidepressants
–antiepileptic drugs (divalproex, topiramate)
–estrogens (menstrual migraine)
