Pain/Related Conditions: Migraine Flashcards
Common migraine triggers
Hormone changes in women
foods
stress
sensory stimuli
Changs in wake-sleep pattern
changes in environment
Migraine diagnosis
headaches last 4-72hrs and recur randomly
headaches have >2 of following (unilateral location, pulsating, mod/severe pain, aggrevated by routine physical activity)
during headache: nausea, vomiting, sensitivity to light/sound
Triptan mechanism of action
selective agonists for the 5-HT1 receptor
vasoconstriction cranial blood vessels, inhibit neuropeptide release and dec pain transmision
1st line for acute txm
should be taken at first sign of headache, but limit to 3-5 headaches per month
Medication overuse headaches
“rebound” headaches
can occur due to overuse of acute headache meds
limit acute headache treatment to 2-3 times per week to avoid
Triptan meds
Eletriptan (Relpax)
Rizatriptan (Maxalt)
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)
Triptan Contraindications
Cerebrovascular disease (stroke, TIA)
uncontrolled HTn
heart disease
use within 24hrs of other triptan or ergotamine-type med
Triptan warnings
risk of inc BP, serotonin syndrome
Triptan side effects
parathesia (tingling/numbness)
Triptan sensations (pressure or heaviness in chest or pressure in neck region)
dizziness
hot/cold sensations
overuse headaches
Triptan notes
ODT, nasal, injections = useful if nausea present
Nasal/injections work faster
Nasal = 1 dose, dont prime
Which triptans should not be used in phenylketonuria patients
Maxalt MLT
Zomig ZMT ODTs
Which triptans can be used in children > 12yrs old
almotriptan tablets
zolmitriptan nasal spray
Treximet (Sumatriptan+ naproxen)
Which triptan approved ages 6-17
Rizatriptan
Triptan duration of action
Frovatriptan = longest half life
Frovatriptan + naratriptan = long acting but slow onset
other triptans have faster onset but shorter half life
Which triptans come as ODT
Rizatriptan (Maxalt-MLT)
Zolmitriptan (Zomig ZMT)
Which triptans come as nasal spray
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)
Which triptans contraindicated with MAOi or within 2 weeks of stopping
Sumatriptan
Rizatriptan
Zolmitriptan
Ergotamine drugs
for patients who dont get benefit with triptans, ergotamine used next
Dihydroergotamine (D.H.E 45, Migrant)
Ergotamine + caffeine (Cafergot, Migergot)
Ergotamine boxed warnings
CI with potent CYP3A4 inhibitors due to life threatening peripheral ischemia
Ergotamine Contraindications
uncontrolled HTN
ischemic heart disease
pregnancy
Ergotamine warnings
Cardiovascular effects
cerebrovascular events
many drug interactions
Ergotamine side effects
nausea
vomiting
Using Ergotamine nasal spray
requires priming
Oral CGRP receptor antagonists
Nurtec
Ubrelvy
Ubrelvy (ubrogepant) is approved to….
treat acute migraines
Nurtec (rimegepant) is approved to…
treat and prevent migraines
Reyvow (Lasmiditan) is class….
V
Fioricet is….
tylenol/butalbital/caffeine
its not control, but the one with aspirin/butalbital/caffeine is
migraine preventative treatment should be considered in pts
pts who use acute treatments > 2 days/week or > 3 times per month
migraines have decreased the quality of life
acute treatments ineffective or CI
Beta-Blockers for migraines
Propranolol
Metoprolol
Antiepileptic for migraines ppx
Divalproex (Depakote)
Topiramate (Topamax)
Divalproex (Depakote) boxed warnings and side effects
Boxed warnings: fetal harm, hepatic failure
Warnings/SE: Weight gain, thrombocytopenia, inc ammonia, alopecia
Topiramate (Topamax) boxed warnings and side effects
Warnings: fetal harm, metabolic acidosis, nephrolithiasis, inc ammonia, open angle glaucoma and visual field defects, oligohidrosis
SE: weight loss, somnolence, cognitive impairment
2 oral CGRP antagonists approved for migraine prevention
Nurtec
Qulipta
Which CGRP antagonist injection is once every 3 months
Vyepti
Which CGRP antagonist injection is once every month
Aimovig
Emgality
How is Ajovy given?
can be given monthly or every 3 months depending on dose
