Migraine

Front 1

What is the pathophysiological mechanism of migraine?

Back 1

Changes in the trigeminal nerve and imbalances in neurotransmitters
Decreases in serotonin leading to chemical release of neuropeptides that trigger vasodilation in cranial blood vessels

Front 2

Triptan MOA:

Back 2

Serotonin agonist that cause vasoconstriction of cranial blood vessels

Front 3

A common type of migraine is a menstrual associated migraine. How are these managed?

Back 3

Oral contraceptives
or
NSAIDs
Triptans
Started 2 days prior to the menses and continued for 5-7 days

Front 4

Migraines in children can be treated with:

Back 4

OTC agents such as ibuprofen
Can use triptans in children

Front 5

Advil migraine =

Exedrine migraine =

Back 5

Ibuprofen

APAP, ASA, Caffeine

***Some people get relief from these, triptans, or other prescription products such as hydrocodone or other opioid combos or tramadol)

Front 6

What agents are available for prophylaxis?

Back 6

Anti-depressants
Anti-convulsants
Vitamins, minerals or natural products

Front 7

What natural products exist for migraine?

Back 7

Feverfew, Willowbark (a salicylate), Butterbur, Magnesium, and Riboflavin

Front 8

Triptans are often used for acute treatment - some patients find OTC products to work better - some patients utilize both

Name the common triptan agents and their brand names:

Back 8

Sumatriptan (Imitrex) - Needless injection, SC (Stat dose), Nasal spray
Rizatriptan (Maxalt) - Tablets, Disintegrating tablets (Maxalt MLT)
Eletriptan (Relpax) - Tablets
Zolmitriptan (Zomig) - Tablets, Disintegrating tablets, Nasal spray
Frovatriptan (Frova)

Front 9

Which triptans come in a nasal spray?

Disintegrating tablets?

Injection?

Back 9

Imitrex (Sumatriptan)
Zolmitriptan (Zomig)

Rizatriptan (Maxalt)
Zolmitriptan (Zomig)

Imitrex (Sumatriptan)

Front 10

Triptan contraindications:

Back 10

Cerebrovascular disease
Uncontrolled hypertension

Caution with other serotonergic medications

Front 11

Triptans can cause "triptan sensations" - what are these like?

Back 11

Pressure on the chest or or neck region and usually dissipate after administration

Front 12

Which triptans have a longer half life and can be used if the pain continues after dosing?

Back 12

Frovatriptan
Naratriptan

Front 13

A recent study found this:

Back 13

Eletriptan (Relpax) to be more effective than Sumatriptan (Imitrex) in relieving pain

Front 14

Imitrex - describe how long you must wait to repeat a dose and the max doses:

What is Treximet?

Back 14

PO: wait 2 hours - repeat only once
NS: wait 2 hours - repeat only once
SC: wait 1 hour - repeat only once

All other formulations seem to need 2 hours before repeat dose except naratriptan is 4 hours

Sumatriptan + Naproxen

Front 15

Important to know about zomig nasal spray:

Back 15

There is only one dose in the nasal spray - do not prime or you will lose it

Front 16

Less commonly used migraine medications:

What is Fioricet?
What is Fiorinal?

Back 16

APAP/Butalbital/Caffeine - also can come with codeine

ASA/Butalbital/Caffeine

Front 17

Ergotamine products are pregnancy category:



What products are available:

Back 17

X - Black box warning
Also do not use with strong CYP 3A4 inhibitors due to risk of cerebral ischemia at higher levels

Ergoloid mesylates (Ergomar, Ergostat), Ergotamine/caffeine (Cafergot)
Dihydroergotamine (DHE-45, Migranal Nasal Spray)

Front 18

Consider using prophylactic treatments if:

Back 18

Patient uses acute treatments more than twice per week if their quality of life is decreased

Front 19

First line for migraine prophylaxis:

Back 19

Beta-blockers (Propranolol - Inderal - most lipophilic, Timolol (Blocadren), Metoprolol) - ideal if high blood pressure
Topiramate (Topomax) - ideal due to weight loss
Valproate - generally avoided due to adverse effects
Extended cycle oral contraceptives if pre-menstrual migraine OR start NSAIDs or triptan 2 days prior to menses and continue for 5-7 days
***Topiramate and Valproate are pregnancy category D***

Front 20

What are "rebound" headaches?

What should be done for them?

Back 20

Medication overuse headaches
Occur from overuse of most headache medications: NSAIDs, narcotics, analgesic combination products, triptans, ergotamines (Except DHE)
Slowly taper off and use only 2-3 times per week