Migraines Flashcards
What are the main types of drugs used to treat migraines?
- Triptans (5-HT 1D/1B agonists)
- Ergot alkaloids
- Non-steroidal anti-inflammatory analgesics
- Tricyclic antidepressants (TCA)
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Migraine prophylaxis (not for acute)
MOA: Vaso constrictor actions, may act on presynaptic terminals to inhibit release of vasodilation peptides; bind to serotonin receptors found on blodvessels in the cerebrum and meninges
Triptans (5-HT 1D/1B agonists)
- sumatriptan = first line
- should not be used for pts at risk for CAD
MOA: vasoconstrictor actions; tend to have multiple actions in the NS (alpha receptors, DA receptors, 5-HT receptors); highly specific for migraines;
Ergot alkaloids
MOA: inhibit the presynaptic terminals
Anti-seizure medication
MOA: control pain
NSAIDS and ibuprofen
ADRs of this drug: Altered sensations (warmth, tingling, etc.), Dizziness, Muscle weakness, Neck pain; contraindicated for patients with CAD or angina
Triptans
Contraindications for specific triptan: Patients with severe hepatitis or renal impairments, or peripheral vascular syndromes
- Naratriptan
- Eletriptan
Contraindications for specific triptan: Patients with peripheral vascular disease
Frovatriptan
Contraindications for specific triptan: Patients with Wolff-Parkinson-White Syndrome (Disorder of the electrical conduction system of the heart)
Zolmitriptan
What are the different types of triptan
- Eletriptan
- Frovatriptan
- Naratriptan
- Rizatriptan
- Sumatriptan
- Zolmitriptan
- Almotriptan
- see ppt for dose, max does, half life
What are some concerns for pts taking triptans?
- expensive
- Duration of the drug’s actions often shorter than the duration of the migraine (May require several sequential doses during a prolonged attack; ADRs can limit the maximal safe dose)
What are the types of ergot alkaloids
- Ergotamine
2. Dihydroergotamine
Ergot alkaloid: less effective when given past produce (feeling that migraine is going to occur); long half-life can lead to overdose; A: PO, sublingual, rectal suppository, inhaler, IV
Ergotamine
Ergot alkaloid: Preferred by come clinicians for intractable migraines; Usually i.v.; Can be intranasally
Dihydroergotamine
What are the types of migraine prophylaxis drugs?
- Propranolol – beta-blocker
- Amitryptyline – TCA
- Anti-seizure medications (Topiramate; Valproic acid)
- Verapamil – Calcium channel blocker
- Flunarizine – CCB used in Europe