NS: Migraines

Question 1

What NSAID is licensed specifically for the treatment of an acute attack of migraine?

Answer 1

Tolfenamic.

Diclofenac, flurbiprofen + ibuprofen are also licensed for use in migraine.

Question 2

The triptans work on what receptors?

Answer 2

5HT1B/1D.

Question 3

The 5HT1-receptor agonists available for treating migraine are almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan.

Which of these are aso used to treat cluster headache?

Answer 3

Sumatriptan and zolmitriptan

Question 4

Antiemetics, such as metoclopramide hydrochloride or domperidone, or phenothiazine and antihistamine antiemetics, relieve the nausea associated with migraine attacks.

Metoclopramide and domperidone have what added advantages?

Answer 4

They promote gastric emptying and normal peristalsis; a single dose should be given at the onset of symptoms.

Question 5

The beta-blockers propranolol, atenolol, metoprolol, nadaolol, timolol are all effective for migraine prophylaxis, what is most commonly used?

Answer 5

Propranolol

Question 6

Pizotifen is an antihistamine and a serotonin-antagonist which has limited use in migraine prophylaxis. What is it structurally related to?

Answer 6

TCA

Can cause weight gain.

Question 7

Cluster headache rarely responds to standard analgesics.

What is the treatment of choice of cluster headache?

Answer 7

Sumatriptan by subcutaneous injection.

If injection is unsuitable, sumatriptan nasal spray or zolmitriptan nasal spray may be used.

Question 8

What can be used for the prophylaxis of cluster headaches? (3)

Answer 8

1. Verpamil
2. Lithium
3. Prednisolone