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36 Cards in this Set

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Drugs used in prophylaxis of migraines (5)
Beta-blockers
TCAs
Valproate
Ca Channel blockers
Methysergide
Drugs used in acute (abortive) treatment of migraines (6)
Sumatriptan
Ergotamine
Dihydroergotamine
NSAIDs (acetaminophen)
Metoclopramide
"combination" analgesics
1st line agents for migraine prophylaxis
Beta-blockers
How long does it take for Beta-blockers to have an effect?
May take a month
Effects increase w/ time
% of people that get benefit from beta-blockers
60 - 80%
2nd line agents for migraine prophylaxis
TCAs
3rd line agent for migraine prophylaxis
Methysergide
Efficacy of Calcium channel blockers vs. beta blockers
Relatively comparable
What is the receptor action of methysergide itself?

What are its effects?
Non-specific 5-HT antagonist
(especially 5-HT2)

VSM contraction
Platelet aggregation
CNS neuron depolarization
What are the anti-migraine effects of methysergide due to?
Its metabolite, methylergonovine
(has serotonergic and alpha-1 agonist properties)
Rare side effect of methysergide
Retroperitoneal fibrosis
What time limitations are there on administering methysergide?
Should NOT be used for more than 6 months

1-2 month holidays every 6 months
What conditions is methysergide contraindicated in (3)?
PVD, HTN, angina
What meds should methysergide NOT be used with?
Beta-blockers
(additive vasoconstriction?)
What type of drug is methysergide?
Semi-synthetic ergot derivative
What types of headaches do sumatriptans work for?
Cluster & migraine headaches
Why does headache recurrence commonly occur w/ sumatriptans?
Short half-life (~2 hrs.)
No accumulation of metabolites
Why is caffeine used w/ ergotamine
Caffeine boosts ergotamine's oral bioavailability
(normally, it is very low)
How is dihydroergotamine different than ergotamine?
Same clinical effects

BUT, fewer/milder side effects
NOT known to produce dependence
When is metoclopramide used for migraines?
When N&V are a prominent symptom

Remember, this is an anti-emetic
How do 2nd generation triptans differ from 1st gens?
Last longer
Cross BBB better
3 examples of "combination" analgesic
Sedative + analgesic + caffeine

Sedative + NSAID + codeine

Sedative + analgesic + sympathomimetic amine
When is sedative + analgesic + sympathomimetic amine contraindicated?
(this is a "combination" analgesic)
HTN, HD, glaucoma, Renal disease
When MAO-Is are being used
What are sumatriptans structurally related to?
Serotonin

Activate serotonin receptors on vessels & nerve endings
Breakdown of elimination of sumatriptans
80% hepatic, 20% renal
What is the major side effect of sumatriptans?
Coronary vasospasm

Note: 1st dose should be administered in front of physician
What drugs do sumatriptans interact with? How?
SSRIs and MAO-Is --> serotonin syndrome

Ergots --> additive vasospasm
What is the receptor action of ergotamine? What are the effects?
Serotinergic, dopaminergic, alpha-adrenergic
(uterine contraction, vasoconstriction, N&V)

Ergot receptors --> stasis, thrombosis, gangrene
What is ergotamine structurally related to?
LSD
What situations is ergotamine contraindicated in?
PVD, HTN, ischemic HD, renal or hepatic disease, pregnancy

Contraindications due to the ergot effects (thrombosis, stasis, etc.)
What can boost the efficacy of NSAIDs and acetaminophen?
Codeine
When are tiptans contraindicated? Why?
In CAD

They cause coronary vasospasm
What is the most commonly used drug for abortion of a migraine?
Sumatriptan
In a mild migraine, how should you treat (2)?
ID and avoid triggering factors
Mild analgesics (anti-emetics if necessary)
In a moderate migraine, how should you treat (2)?
Triptan [preferred over ergots](IF CAD not present)

"Combination" analgesic (IF CAD is present)
In a severe migraine, how should you treat (3)?
Triptan or ergot
Anti-emetics
Try prophylaxis for 6 months and reassess