Migraines

Question 1

Discuss the etiology of migraine headaches

Answer 1

it’s unilateral, 4-72 hours, sometimes with photophobia and phonphobia

genetic component

not related to vascular system

we don’t know cause of migraines, but serotonin receptor agonists are therapeutic

Question 2

Describe the mechanism of action of antimigraine drugs

Answer 2

OTC meds for acute migraines are COX inhibitors or acetaminophen

moderate to severe treated with triptans (sumatriptan, zolmitriptan, more) which are 5HT agonists, contraindicated with HTN, MI, and cerebrovascular disease and MAO inhibitors (b/c MAO metabolizes triptans)

ergotamine is a mushroom based alkaloid, can be used to abort migraine but more side effects than triptans, causes smooth muscle contraction and uterine contraction, contraindicated in pregnancy and HTN

prophylactics: Propanolol, topirimate (antiseizure), amitryptiline (tricyclic ad), verapimil (Ca2+ blocker), ibuprofen, botox, we don’t know how these work

Question 3

Contrast drugs used to treat acute attacks, and those used to prevent migraines prophylactically

Answer 3

acute attack treatment is triptans (sumitriptan) or ergotamide, both cause vasoconstriction

prphylactics are a wide array of pharmaceuticals, ibuprofen, verapimil, propanolol, amitryptiline, botox, topirimate, we don’t know how they prohylact migraines

Question 4

Summarize the adverse effects of antimigraine drugs

Answer 4

vasoconstriction

ergotamine and dihydroergotamine cause vasoconstriction and uterine contraction, will cause stillbirth in pregnant women