Migraines

Question 1

Migraine dx

Answer 1

At least 2 features of the following…
- unilateral head pain
- throbbing pain
- worse with activity
- mod/severe pain
And at least 1 of the following…
- N/v
- photophobia
- phonophobia

Question 2

Migraine classes

Answer 2

• no aura–most common
• aura–visual, sensory, or motor
• chronic–15d/M for 3M

Question 3

How do chronic migraines begin

Answer 3

often episodically, inc with time

Question 4

Risks for migraine

Answer 4

Family, hormones (est and prog), menstruation and pre-menses

Question 5

Migraine triggers

Answer 5

excess or dec sleep, stress, fatigue, missed meals, overexertion, weather changes, red wine, bright lights and strong smell

Question 6

Protective fx for migraines

Answer 6

menopause and preg

Question 7

Patho of migraines

Answer 7

Changing brain metabolism and blood flow
- chx NT levels causes hyperactivity and activates the vascular sys to cause vasodilation

Question 8

4 phases of migraines

Answer 8

premonitory, migraine aura, HA, recovery phase

Question 9

Premonitory phase

Answer 9

1/3 of people
- fatigue, irritable, lose concentration, stiff neck, food cravings

Question 10

Migraine aura

Answer 10

• 1/3
• lasts up to an hour

Question 11

HA phase

Answer 11

throbbing, fatigue, dizzy, vom, hypersens to touch
- 4-72h

Question 12

recovery phase

Answer 12

irritable, fatigue, depression for hours to days

Question 13

Abortive therapy for migraines

Answer 13

• for mild/mod pain w/o nausea
• NSAIDs, ASA, acetaminophen
• more effective when given early
• 1st line

Question 14

best way to give triptans

Answer 14

in combo with other drugs

Question 15

Antiemetics given for migraines

Answer 15

phenergan and zofran

Question 16

Who gets preventative migraine meds?

Answer 16

If over 4 migraines/M or last over 12 h

Question 17

Preventative migraine meds

Answer 17

• give triptan or CGRP
• beta blocker (propanolol)
• tricyclic antidepressants
• antiepileptics (divalproex and topiramate)
• estrogens for mentstrual migraines

Question 18

Goal of prevenetative migraine tx

Answer 18

dec severity and freq, dec disability, dec chronic prevalence, inc effectiveness or attack tx

Question 19

Sumatriptan class and MOA

Answer 19

• selective Sr rec antagonist
• Constrict intracranial BVs, suppress release of inflam neuropeptides, block brain pathways for pain

Question 20

Meds for acute migraines

Answer 20

sumatriptan and rimegepant

Question 21

Sumatriptan SE and NC

Answer 21

• Soreness at injection site, chest pressure, flush, weak, HA, bad taste (nasal)
• SQ, PO, intranasal
• avoid with ischemic stroke or heart disease and angina
• nasal spray has least SE

Question 22

When is Rimegepant given?

Answer 22

When triptans are not effective or CI (like ischemic stroke or HD and angina)

Question 23

Rimegepant class and MOA

Answer 23

• CGRP antagonists
• mediates pain transmission

Question 24

Rimegepant SE and NC

Answer 24

• GI upset
• PO
• CYP substrate