Sketchy Pharm: Triptans and Migraine

Question 1

How is the trigeminal nerve involved in migraines?

Answer 1

Its afferents from the cranial arteries seem to be unusually activated; this results in release of neurokinin A, substance P, and GCRP onto the meningeal arteries –leading to vasodilation and protein extravasation

Question 2

What is the first-line treatment for migraines?

Answer 2

Triptans –specifically sumotriptan

Question 3

What is the mechanism of sumotriptan?

Answer 3

It is an agonist of the 5HT-1d and 5HT-1b receptors (in the meningeal vessels, trigeminal nerve, and brainstem – the tri-gem hat, the meningeal headband, and the brainstem hair)

Question 4

What effect does stimulating the 5HT-1d and 5HT-1b receptors have?

Answer 4

It causes vasoconstriction of the meningeal arteries and causes less vasodilatory cytokines to be released from the trigeminal nerve.

Question 5

In what patients are triptans contraindicated?

Answer 5

Those with angina; triptans work by causing vasoconstriction. Vasoconstricting the coronary arteries can worsen angina. (Guy falling on the artisan working the angina anvil.)

Question 6

What other condition can be treated with triptans?

Answer 6

Cluster headaches – think of the cluster of lanterns behind the wrestlers.

Question 7

___________ work well for acute migraine flares.

Answer 7

NSAIDs

Question 8

What treatments are used for long-term migraine prophylaxis?

Answer 8

Calcium blockers (the soft-serve – which contains lots of calcium –with blocked channels next to the long-time fans)

Beta-blockers

Valproic acid (an antiepileptic; think of the festiVAL of PRO wrestling)

Topiramate (another anti-epileptic; think of the child with the toupee)

TCAs (child on tricycle)