Migraines Flashcards
In what population are migraines more prevalent?
Before puberty, more common in boys
After puberty more common in women
What are the symptoms of a migraine?
Unilateral or bilateral throbbing, nausea, preceded by a visual aura Variable duration (hours to days), variable incidence (few per year to per month)
What are some triggers of migraines?
Weather, missing a meal, stress, alcohol, various types of food (cheese, wine, chocolate), crying, menses
How can an acute migraine headache be treated?
1st: NSAIDs
2nd: Combination of acetaminophen, ASA and caffeine
3rd: opioid
Ergot alkaloids (not used anymore), ergotamine, coanalgesic with caffeine
What are some of the problems with ergot alkaloids?
Liver disease, rebound headache with frequent use, cardiovascular disease, arteriolar vasoconstriction, poor peripheral circulation, Raynaud’s
Where do ergot alkaloids come from?
A toxin produced by wheat (st. anthony’s fire)
What are triptans used for?
Management of an acute migraine headache (expensive_
How do the triptans work?
Serotonin receptor agonist
What are the side effects of the triptans?
Similar to ergot alkaloids
What is are some drug interactions with the triptans?
MAOi or SSRI antidepressants (serotonin syndrome: restlessness, muscle twitches, myoclonus, sweating, seizures)
Ergot alkaloids
How can propanolol (beta-blockers) help in migraine prophylaxis?
Regulates blood flow, reduces blood pressure
What are some side effects of propranolol?
Tiredness, dizziness, decreased libido, dreams, exacerbate asthma
What drugs are used for migraine prophylaxis?
Beta-blockers, amitryptiline (TCAs), gabapentin (anticonvulsant), candesartan (angiotensin II antagonist)
What are some side effects of amitryptiline?
Dry mouth and eyes, drowsiness (much lower does than used for depression)
What dietary supplements can be used for migraine prophylaxis?
Riboflavin, Coenzyme Q10, Magnesium citrate
weak data supporting, but no side effects
