Migraines 2

Question 1

Migraine - acute attacks in 12-17yrs

Answer 1

1. simple analgesia (paracetamol, NSAID) NOT aspirin <16 (Reye’s)
2. nasal triptan (oral unlicensed in <18!!)
3. nasal triptan + NSAID/paracetamol + antiemetic (metoclopramide unlicensed or prochlorperazine)

Question 2

Oral triptans age

Answer 2

not licensed in <18 give nasal instead

Question 3

Women who have migraine with aura should not use this type of contraception - why

Answer 3

CHC contraindicated
in migraine, esp migraine with aura, CHC use may increase risk of vascular events
avoid!!

vascular events e.g. blood clots, aneurysm, PAD, CAD, cerebrovascular di

Question 4

Triptans - 2 main interactions

Answer 4

Serotinergic drugs e.g. lithium, vortioxetine, SSRIs, tramadol, buproprion, trazadone etc

MAOIs (mocobemide, isocarboxazid, tranylcopromine, phenelzine) - These moderately increasesthe exposure to Sumatriptan. Manufacturer advises avoid (and for 14 days after stopping MAOI for irreversible ones)

Question 5

Triptans interaction with MAOIs

Answer 5

SEVERE

they moderately increases the exposure to triptans. Manufacturer advises avoid (and for 14 days after stopping except moclobemide)

Question 6

Triptans - contraindicated in which patients and why?

Answer 6

mild uncontrolled hypertension
moderate and severe HTN
previous MI
previous TIA
etc

this is because it works by constricting blood vessels - which will. make these conditions worse!

Question 7

Triptan can be repeated after 2 hours (4 hours for this drug) ONLY if there has been response to first dose, but not fully adequate

Answer 7

naratriptan

Question 8

when can you use an oral calcitonin gene related peptide inhibitor

Answer 8

prophylaxis of migraine in pt in whom at least 3 prophylactin treatments have been ineffective

rimegepant - episodic migraine, at least 4x attacks a month

atogepant: episodic or chronic migraine, at least 4 migraine days a month

Question 9

name the 2 oral calcitonin gene related peptide inhibitor and state when they can be used

Answer 9

prophylaxis of migraine in pt in whom at least 3 prophylactin treatments have been ineffective

rimegepant - episodic migraine, at least 4x attacks a month

atogepant: episodic or chronic migraine, at least 4 migraine days a month