Treatment of HAs

Question 1

Used in prophylaxis of migraines
Take 3 weeks to be effective
Mechanism is unclear
Reduced energy, tiredness
contraindicated in pts with asthma

Answer 1

Beta blockers
Propranolol and Atenolol
propane and antenna lol’ing

Question 2

Prophylaxis of migraines
mechanism unclear
Inhibit serotonin reuptake
cause weight gain and tiredness

Answer 2

TCAs
amitriptyline and nortriptyline
“ami and nora tripped and fell on their heads”

Question 3

Px of migraines

MOA unclear, increase GABA signaling

Answer 3

Anticonvulsants

Valproic acid, topiramate, gabapentin, Levetriracetam

Question 4

Contraindicated in pregnancy due to teratogenicity

causes drowsiness, nausea, ataxia, alopecia, tremor, and liver toxicity

Answer 4

Valproic acid

Question 5

calcium channel blocker
antihypertensive, Px of migraines
MOA unclear
negative inotropic effects and hypotension

Answer 5

Verapamil

Question 6

Px of migraines
histamine antagonist
Ach and serotonin antagonist
used for seasonal allergy and pruritus

Answer 6

Cyproheptadine

Question 7

mild to moderate migraine abortion
nonspecific pain reduction agents
(4 examples)

Answer 7

NSAIDs, Ibuprofen, naproxen, acetaminophen, ketorolac

Question 8

mild to moderate migraine abortion

combined with caffeine to increase efficacy

Answer 8

acetaminophen, aspirin, ibuprofen, naproxen

Question 9

moderate migraine abortion
nonspecific pain reduction agent
given IV or PO for max 5 days

Answer 9

ketorolac

Question 10

which two nonspecific agents are given to children and pregnant women to stop migraines?
which nonspecific agent should be avoided during the last trimester of pregnancy?

Answer 10

acetaminophen and ibuprofen

NSAIDs because they close ductus arteriosus and increase bleeding

Question 11

Migraine abortive therapy
agonist at 5-ht1 receptors
partial agonist and antagonist at serotonergic, dopaminergic, and adrenergic receptors
very widespread side effects, causing nausea and vasoconstriction

Answer 11

ergot alkaloids

Question 12

which ergot is given sublingual?

Answer 12

ergotamine

ergot, it’s mine. i’m hiding it under my tongue.

Question 13

which ergot is given sc, im, iv, or nasal spray?

Answer 13

dihydroergotamine

this ergot is also mine, but i can take it in a variety of ways.

Question 14

contraindications for ergotamine and dihydroergotamine

Answer 14

pregnancy X (fetal stress, miscarriage, vasoconstriction)
peripheral vascular disease
ischemic heart disease
within 24 hours of triptans

Question 15

migraine abortive therapy
causes less vasoconstriction and nausea than ergots
selective MOA: 5-HT1 receptor agonism

Answer 15

triptans

Question 16

Triptan effects:
vascular
neurogenic
central

Answer 16

• vasoconstriction of cranial blood vessels
• reduction of trigeminal sensory nerve activation and inhibition of vasoactive neuropeptide release
• inhibition of NT release from trigeminal nerves in the brainstem and upper cervical spine

Question 17

short onset triptan

sq, PO, or nasal spray

Answer 17

sumatriptan

sumo tripped and fell on your head

Question 18

greater bioavailability than sumatriptan
lipophilic and greater CNS distribution
P450 metabolism
lower dose in renal dysfunction

Answer 18

noratriptan and zolmitriptan

Nora’s ohms. Imagine nora tripping and getting upset, so she sits down to meditate. Unfortunately, as she’s sitting she realizes that he kidneys really hurt, but her brain is highly active.

Question 19

longest acting triptan
highest affinity for 5-HT1B receptors
slower onset

Answer 19

Frovatriptan

frova the triptan, likes the 5HT1B, he was really slow as the people know just the same as you and me

Question 20

quick dissolving sublingual tablet
faster onset, less nausea than sumatriptan
MAO metabolism

Answer 20

Rizatriptan

rizatriptan rapidly rises to your brain

Question 21

Triptan side effects:
CNS
peripheral
MSK

Answer 21

HA recurrence, drowsiness
tingling, paresthesias, dizziness
neck stiffness

Question 22

drug interactions of triptans

Answer 22

SSRIs: causes serotonin syndrome due to inhibition of serotonin reuptake and simultaneous 5HT1B agonism (restlessness, hallucinations, diarrhea)
within 24 hours of ergots

Question 23

Abortive therapy for cluster HAs

Answer 23

oxygen

triptans

Question 24

Gold standard Px for cluster HAs

Answer 24

high dose prednisone

verapamil

Question 25

Acute Tx for tension HAs

Answer 25

nonspecific anti-inflammatory drugs: acetaminophen and NSAIDs

Question 26

Px for tension HAs

Answer 26

TCAs

Gabapentin

Question 27

Lifestyle changes for treating IIH

Answer 27

weight loss
removal of drugs like tetracycline, oral contraceptives
reducing vitamin A hypervitaminosis

Question 28

acute Tx of IIH
what class?
side effects?

Answer 28

CA inhibitors to reduce CSF production
acetazolamide and topiramate
nausea, fatigue, tingling in extremities, weight loss, loss of concentration

Question 29

What are the three drug classes used in Px of migraines?

Order them from most to least commonly used

Answer 29

• beta blockers
• TCAs
• anticonvulsants

Question 30

Name the two drug classes used for abortive therapy of migraines.

Answer 30

• ergot alkaloids

- Triptans