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8 Cards in this Set
- Front
- Back
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Migraine
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Trigimenial sensory nerves in meninges activated by stretch and inflammatory mediators.
Inflammation is sterile and initiated by neuropeptides and sustained by autocoids. |
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Sumatriptan
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Mechanism: 5-HT agonist, activates 1B/1D receptors -> vessel constriction, reduced inflammatory mediators
Clinical Use: anti-migraine, cluster headache Side Effects: coronary vasospasm, little other effect on peripheral vasculature Druge Interaction: cannot use with SSRIs or MAOIs ("serotonin syndrome") |
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Ergotamine
Dihydroergotamine |
Mechanism: partial agonist of 5-HT, DA, alhpa-1; vasoconstriction, may cause dependence
Clinical Use: second line drug (Triptans preferred) for migraine Side Effects: ergotism (vascular stasis, thrombosis, gangrene), peripheral vessel constriction, uterine contractions, emesis |
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NSAIDs
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mild migraine pain
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Butalbital
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Barbiturate (butalbital) + NSAIDs (or acetaminophen) + caffeine
Used only if Triptans do not work |
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Propranolol
Timolol |
Mechanism: beta-antagonists
Clinical Use: First line drugs for migraine prophylaxis Side Effects: HDL, somnolence, depression |
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Amitryptiline
Nortryptyline |
Mechanism: TCAs
Clinical Use: Second line migraine prophylaxis Side Effects: anticholinergic, sedation and weight gain |
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Methysergide
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Mechanism: 5-HT antagonist, may have metabolite with 5-HT and alpha-1 AGONIST properties
Clinical Use: Third line for migrain prophylaxis Side Effects: Inflammatory fibrosis of lung, need 1-2 month drug holiday every 6 months |
