Pharm Management of Headaches Flashcards
When would you choose to use a -triptans over an NSAID in termination of a migraine?
NSAIDs = first line, mild-moderate pain
use -triptans for more severe migraines or those that don’t respond to NSAIDs
Do you choose -triptans or ergot alkaloids first? Why?
-triptans bc ergot alkaloids aren’t as effective and they carry risk of vascular occlusion and gangrene
Vascular occlusion and gangrene are rare but major SEs for which drug?
ergot alkaloids
What 6 drugs can be used for migraine prophylaxis?
beta blockers, anticonvulsants, antidepressants, calcium channel blockers, NSAIDs, 5Ht2 receptor antagonists
Name 6 drugs for migraine abortion in order from mild–> severe pain tx.
NSAIDs, triptans, ergot alkaloids (ergotamine/DHE), isometheptene, tramadol
What are some contraindications for NSAIDs?
acute gastritis peptic ulcer disease renal insufficiency bleeding disorders chronic use/prolonged periods
Name some non-pharm preventions for migraines.
avoid triggers
Are NSAIDs used for migraine abortion or prevention?
both
How do the triptans work?
they’re 5T 1b-1d agonsists (reverse vasoconstriction; prevent neuroinflammation; prevent activation of pain fibers)
How do the ergot alkaloids work?
they’re 5HT 1b-1d receoptor agonists (reverse vasoconstriction; prevent neuroinflammation; prevent activation of pain fibersreverse vasoconstriction; prevent neuroinflammation; prevent activation of pain fibers)
What is a problem with treating headaches with drugs?
you can develop analgesic overuse headaches
What is the first-line drug for migraine prophylaxis?
beta blockers (propranolol)
What is Spreading Cortical Depression and what does it cause?
a self-propagating wave of neuronal and glial depolarization that causes aura of migraine, activates trigeminal afferents, and changes the BBB permeability –> vasodilation, pain
This is a self-propagating wave of neuronal and glial depolarization that causes aura of migraine, activates trigeminal afferents, and changes the BBB permeability –> vasodilation, pain.
Spreading Cortical Depression
How does sensitization affect migraines?
causes throbbing pain, worsening of pain w/ mvmt or coughing, etc
How does serotonin affect migraines?
unsure phys for generation of migraine, but we know agonists are good tx’s
What is Imitrex?
a triptan (sumatriptan)
On which receptor does ergotamine (DHE/Migranal) act? What kind of receptor is it? What is the effect??
serotonin 1B (Gi/o) –> presynaptic inhibition –> prevent vasoconstriction
On which receptor does sumatriptan (Imitrex) act? What kind of receptor is it? What is the effect??
serotonin 1D (Gi/o) –> decrease presynaptic release–> prevent vasoconstriction
Which drug? serotonin 1D (Gi/o) --> decrease presynaptic release--> prevent vasoconstriction
sumatriptan (Imitrex)
Which drug? serotonin 1B (Gi/o) --> presynaptic inhibition --> prevent vasoconstriction
ergotamine (DHE/Migranal)
What is DHE?
an ergot alkaloid (dihydroergotamine)
What are some rare but major SEs of the triptans?
coronary vasospasm, angina, MI, arrhythmia, stroke
What causes vascular occlusion and gangrene in ergot alkaloid use?
alpha-1 adrenergic vasoconstriction
Where does Acetaminophen act on COX-2?
centrally
How many migraines/month are needed to classify it as chronic?
15+
Botox is only used on _____ migraines.
chronic
What is the mechanism of action of Botox?
block ACh release
What are some negatives to Botox tx for migraines?
it’s expensive
has to be administered by a pro
can give HAs, neck pain, muscle weakness, ptosis
category C in prego
