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39 Cards in this Set
- Front
- Back
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What are the prototype migraine drugs?
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Sumatriptan
Ergotamine |
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What is the "cortical spreading depression" model of migraines?
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A wave of electrical activity across the cerebral cortex that releases calcitonin-gene related peptide and other vasodilators and inflammatory signals.
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What is the phenomenon of central sensitization?
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Believe that trigeminal nerve activation cause nerves to become painfully sensitive. Then move from peripheral sensitization to more central sensitization propagating the migraine.
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What are the two therapeutic strategies to treat migraines?
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Abortive
Prevention |
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What are the clinical endpoint for assessing the efficacy of abortive therapy?
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Pain free (return to normal fx) in two hours, lasting 24 hours.
Medication works consistently in the majority of attacks. |
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What drug classes are used for abortive therapy for migraines?
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5HT agonists
Analgesics |
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What is the common adjunct for abortive migraine therapies?
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Antiemetics
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What is the first line migraine abortive therapy for pts not responding to NSAIDs?
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Triptans
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Discuss Triptans: Disease treated, mechanism, major side effect.
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Migraines (Abortive)
5-HT (1D and 1B) agonist: decreasing CN V excitability and inflammatory peptide release (pre-synaptic 1D), vasoconstriction (vascular 1B) |
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What if a patient does not respond to a triptan? What is triptan switching?
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There are 7 triptans with different half-lives and varying efficacy. Pts can often try different ones (Triptan switching) or in combination (stratified care) for better results.
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Where are triptans metabolized?
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Liver
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What are the side effects of triptans?
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Dizzy
Drowsy Chest, jaw, neck tightness |
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What are the contraindications for triptans?
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Heart disease
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What is serotonin syndrome?
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Sweating, agitation, diarrhea, rigidity, seizures potentially causing death due to increased serotonin
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What is a potential risk of using triptans for abortive therapy?
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Serotonin syndrome
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What are the migraine abortive drugs?
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Triptans
Ergot alkaloids NSAIDs |
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What are common combination abortive therapies used as migraine abortive therapies?
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Aspirin/caffeine/barbiturate butalbital
Tylenol/aspirin/caffeine Sumatriptan/naproxen |
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Why is caffeine used in combination drugs?
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enhances analgesic effect
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Which Ergot alkaloids are used in abortive treatment of migraines?
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Ergotamine
Dihydroergotamine |
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Discuss Ergotamine: Disease treated, mechanism, major side effect.
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Migraine (abortive)
Non-selective 5-HT agonist N/V, ergotism |
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What is the effect of caffeine in the brain?
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Vasoconstriction (enhances the speed of absorption and peak concentration of ergotamine)
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What is the weaker form of ergotamine?
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Dihydroergtamine
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What are contraindications for ergotamine?
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Heart disease
Vasospasm Prego-- If prego, no ergo! |
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What primary analgesics are used as abortive migraine therapies?
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Acetylsalicyclic acid
Ibuprofen Acetaminophen |
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What antiemetic are used in migraine therapy?
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Metoclopramide
Prochlorperazine |
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Which narcotic analgesic is used in migraine abortive therapy? What is the route of administration?
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Butorphanol
Nasal spray |
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If a pt has frequent migraine attacks, what therapy strategy is used?
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Preventative with drugs used on a chronic basis to reduce the frequency, duration and intensity of attacks
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What are the mechanisms of preventative migraine drugs (5)?
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Stop cortical spreading depression
Stop peripheral and central sensitization Enhance antinociception Block inflammation Modulate sympath, parasympath, and 5HT tone. |
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What drug classes are used as preventives for migraines?
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Beta blockers
Antidepressants Anticonvulsants |
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What is the drug of choice of preventative migraine therapy?
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Propranolol
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What preventative migraine drug would be best for a pt with asthma?
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Atenolol
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What antidepressants are used for migraine prevention?
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Amitriptyline
Fluoxetine |
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Which anticonvulsants are used for migraine prevention?
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Valproic acid
Topiramate Gabapentin |
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Which NSAID is used as prevention for migraines?
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Naproxen
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Is verapamil used to abort or prevent migraines?
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Prevent
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When is Methysergide used? Why?
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For severe refractory migraines due to fibrosis (abdomen and heart) with use more than 6 months.
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What is the mechanism of methysergide?
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Semisynthetic ergot with serotonergic agonist properties.
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What supplements are use to treat migraines?
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Mg
Riboflavin CoQ |
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Why is botulinum toxin A used to treat migraines?
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Injections could reduce local release of nociceptive neuropeptides.
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