Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
12 Cards in this Set
- Front
- Back
|
migraines
definition |
chronic neurovascular disorder
- recurrent attacks of severe headache - autonomic nervous system dysf(n) classification based on wheteher an aura is present or not nausea in 90%, vomiting in 50% prodrome of mood changes, stiff neck, fatigue hours to days b/f the attack |
|
|
Migraine
treatment principles |
abortive therapy
- successful treatment depends on 1. early intervention wrt to onset of ha 2. adequate dosing preventive tx when: - unresponsive to abortive meds - severe attacks - 2 or > / month - rebound ha - all meds exepts triptans cause this |
|
|
Migraine
Drug TX - abortive OTC |
- ASA, APAP, ibuprofen for mild to mod
- combinations of above w/caffeine - Excedrine Migraine (APAP, ASA, caff) |
|
|
Migraine
Drug TX - abortive, non-specific meds? |
Fioricet
butalbital, APAP, caffeine Fiorinal, butalbital (a barbiturate), ASA, caffeine Midrin isometheptene (vasoconstrictor) dichloralphenazone (sedative) APAP butorphanol nasal spray only opioid with evidence for efficacy against migraine |
|
|
Migraine
Drug TX - abortive ergotamine products (alone) |
Ergomar - SL tab
Ergostat, Wigrettes Gynergen - injection Medihaler-Ergotamine - inhaled |
|
|
Migraine
Drug TX - abortive ergotamine products (combos) |
w/caffeine
- Cafergot, Wigraine w/pentobarbital (sedation) and belladona (antiemetic) - Bellergal, Bellamine, Bellaspas, Durgal-S w/all 3 above - Cafergot PB, Wigraine-PB |
|
|
Migraine
Drug TX - abortive dihydroergotamine (DHE) |
D.H.E. injection
Migranal nasal spray |
|
|
Migraine
Drug TX - abortive Triptans |
almotriptan (Axert)
sumatriptan (Imitrex) - generic available now - oral, nasal, injection eletriptan (Relpax) frovatriptan (Frova) rizatriptan (Maxalt) -fastest oral onset of action (30min) zolmitriptan (Zomig) - oral and nasal naratriptan (Amerge) nasal sprays and injection fastest onset of action (10-20min) |
|
|
Migraine
Drug TX - abortive triptans - moa, clinical considerations |
can cause vasospasm therefore CId in
- IHD, MI, uncont HTN, other heart DZ - MAOI depress degredation of triptans - stop MAOI for 2 wks b/f start triptan - don't use w/in 24h of using ergot alkal SSRIs no more effective than placebo |
|
|
Migraine
Drug TX - preventive Drugs of choice |
BBs - *propranolol* and timolol only
Anticonvulsants - divalproex na - na valproate - topiramate antidepressants - amitriptyline (TCA) only TCA |
|
|
more about VPA and formulations
|
Divalproex Sodium (Depakote)
* Depakote and Depakote ER * generic versions now available * compound of Na valproate and VPA in a 1:1 molar relationship Sodium valproate * the sodium salt of valproic acid * Depacon - IV * Depakene - Syrup * (Depakene capsules are VP acid) |
|
|
Migraine
nonpharm |
resting, sleeping in cool, dark place
cold compress to the head relaxation training, thermal biofeedback, cognitive behavioral tx, electromyographic biofeedback trigger management |
