Pharmacotherapy of Migraines Flashcards
Overview of treatment
AVOID ANALGESIC OVERUSE MAX OF 2-3 DAYS PER WEEK
Preventative
4 or more attacks/month with disability at least 3 days/month
Abortive
Educate on medication overuse
Mild-moderate: NSAID, tylenol
Moderate-severe: triptans/ergots
Valproate and topiramate
1st line for preventive
Valproate: 500-1500 mg/day
Topiramate: 50-100 mg/day
NOT RECOMMENDED IN CHILD BEARING AGE WITHOUT CONTRACEPTION
Propranolol and metoprolol
1st line for preventive
Propranolol: 80-240 mg/day
Metoprolol: 100-200 mg/day
NOT RECOMMENDED IN ASTHMA OR RAYNAUD’S
Butterber
150 mg/day
Amitriptyline
2nd line for preventive
25-150 mg/day
not FDA-approved
Triptans
selective 5-HT1b and 5-HT1d receptor agonists
SE: tingling, dizziness, drowsiness, fatigue, chest tightness, flushing
Drug interactions: SSRI/SNRI, CPY3A4 inhibitors (eletriptan), propranolol, MAO-I
Warnings/precautions with TRIPTANS
MI
Pain/tightness/pressure in chest/throat/neck/jaw
CVA, HTN
Peripheral vasospasms
GI ischemic reactions
Medication overuse
Sulfa allergy
Corneal opacities
Seizures
Contraindications with TRIPTANS
Within 24 hours of an ergot/triptan
Within 2 weeks of a MAO-I
CAD, angina, stroke/TIA, arrhythmias, uncontrolled HTN, PVD
Hemiplegic, basilar migraines
Ischemic bowel disease
Severe hepatic impairment
Ergot alkaloids
SE: retroperitoneal, pleuropulmonary, and valvular fibrosis, ergotism, ischemia, cyanosis, gangrene, numbness, n/v
drug interactions: 3A4 inhibitors
Warnings and precautions of ergot alkaloids
BLACK BOX: peripheral ischemia
Cardiac valvular fibrosis
Vasoconstriction
Cerebrovascular events
Egotism
Contraindications with Ergot alkaloids
CAD, uncontrolled HTN, PVD
Hepatic/renal impairment
Calcitonin Gene-related peptide receptor antagonist
END IN PANT
abortive treatment
CI with strong 3A4 inhibitors
Drug interactions: moderate/severe 3A4 inducers and inhibitors, p-gp inhibitors
Lasmiditan
warnings/precautions: medication overuse headaches, sedation, dizziness, serotonin syndrome, DRIVING IMPAIRMENT
SE: dizziness, sedation, fatigue
Drug interactions: p-gp, BCRP substrates
Monitor: LFT, BP, HR,
