Wk 3 Migraines Flashcards
How long does a migraine last?
Between 4 and 72 hours
To diagnose a migraine, the patient must have TWO of these features… (4)
Unilateral head pain
Throbbing pain
Worsens with activity
Moderate/Severe pain
In addition, to diagnose a migraine, the patient must also have ONE of these symptoms… (3)
N/V
Photophobia
Phonophobia
What is photophobia?
Sensitivity to light
What is phonophobia?
Sensitivity to sound
Migraines are typically classified in three ways, which are…?
Migraine with aura
Migraine without aura
Chronic migraine
What does aura mean?
Visual, sensory, or motor symptoms
What are chronic migraines?
Typically occur as episodic and increase in frequency in time
What is the duration of chronic migraines?
At least 15 days a month for 3 months
In women, migraines occur more frequently during…
menstruation, before and after
In women, migraines decrease in frequency during…
pregnancy and menopause
How is estrogen and progesterone believed to trigger migraines in women?
The cyclic withdrawal of these hormones
What are 3 risk factors for migraines?
Family history
Estrogen and progesterone
Genetic and environmental factors
List 8 potential triggers for migraines
Fatigue Oversleeping Missing meals Overexertion Weather change Stress Hormonal changes Bright lights or strong smells
What is the pathophysiology of migraines?
There is no identifiable pathophysiology
What are 2 physiologic associations with migraines?
Brain metabolism
Blood flow
Describe the CNS neurotransmitter change theory of migraines
There is an increase in neuronal depolarization which results in hyperactivity
Describe the blood vessel tone theory of migraines
Release of excitatory neurotransmitters activates the vascular system which stimulates vasodilation
1/3 of migraine sufferers have __ symptoms
premonitory
What are the 4 phases of migraines?
Premonitory
Migraine aura
Headache phase
Recovery phase
What are the 5 potential symptoms of the premonitory phase?
Fatigue Irritability Loss of concentration Stiff neck Food cravings
How long do aura symptoms last?
Up to 1 hour
How many migraine sufferers experience aura?
Up to 1/3
Aura symptoms can be… (3)
Visual, sensory, or motor
Throbbing pain in the headache phase usually starts with…
One side of the head and then spreads to the entire head
How long does the headache phase last?
4-72 hours
What are the symptoms of the headache phase?
Throbbing pain Fatigue Nausea Vomiting Dizziness Hypersensitivity to anything touching the head
What are the symptoms of the recovery phase?
Irritability
Fatigue
Depression
How long does the recovery phase last?
Hours to days before it resolves
What is the first line therapy for migraines?
NSAIDs
Aspirin
Acetaminophen
What is abortive therapy?
Symptomatic therapy
What is first line therapy for migraines used for?
Mild to moderate attacks without severe nausea and vomiting
Why are NSAIDs, aspirin, and acetaminophen tried first?
They can be effective and are less expensive
What are triptans?
serotonin (1b/1d) receptor agonists
Triptans are often coupled with what type of drug?
NSAIDs
If the migraine is accompanied with severe nausea and vomiting, what can be added?
Anti-emetic
What is used to moderate-severe attacks without nausea and vomiting?
Oral migraine specific agents as our first line of treatment, sumatriptan and naproxen
If the patient cannot tolerate triptans, what is the alternative medication?
Calcitonin Gene-related Peptide (CGRP) Agonists
What drug represents the class of serotonin receptor agonists for migraines?
Sumatriptan
What class of drug does sumatriptan belong to?
serotonin receptor agonists
What are the 3 MOA of sumatriptan?
- Constrict intracranial blood vessels
- Suppress release of inflammatory neuropeptides
- Block brain pathways for pain
What 3 routes can sumatriptan be give?
PO
Intranasal
SQ
Sumatriptan should be avoided in patients with what 3 conditions?
Heart disease
Ischemic stroke
Angina
What are the major adverse reaction of sumatriptan? (6)
Injection site reaction, chest pain, flushing, weakness, headache, bad taste (nasal)
What is the brand name of sumatriptan?
Imitrex
What type of drug is rigemepant?
CGRP agonist
What drug represents the drug class CGRP agonists?
rigemepant
When is rigemepant used?
When triptans aren’t tolerated or are contraindicated
What is the MOA of rigemepant?
Mediates pain transmission
What route is rigemepant given?
PO
What is the major adverse reaction of rigemepant?
GI upset
What is a nursing consideration of rigemepant?
CYP substrate, use with caution with medications that are inhibitors/inducers of CYP system
When is preventative therapy recommended?
When someone suffers more than 4 migraines per month or their migraines last longer than 12 hours, or has chronic migraines
What are 4 classes of drugs that are used in preventative therapy for migraines?
Beta-blockers
Tricyclic antidepressants
Anti-epileptic drugs
Estrogens
What beta blocker is typically used for preventative migraine therapy?
Propanolol
What tricyclic antidepressants are typically used for preventative migraine therapy?
Amitriptyline
Venlafaxine
What is the initial preventative therapy for migraines?
Propanolol and amitriptyline/venlafaxine
What are anti-epileptic drugs that are use in preventative treatment of migraines?
divaloprex
topiramate
