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20 Cards in this Set
- Front
- Back
What is the pathophysiological mechanism of migraine?
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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 |
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Triptan MOA:
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Serotonin agonist that cause vasoconstriction of cranial blood vessels
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A common type of migraine is a menstrual associated migraine. How are these managed?
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Oral contraceptives
or NSAIDs Triptans Started 2 days prior to the menses and continued for 5-7 days |
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Migraines in children can be treated with:
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OTC agents such as ibuprofen
Can use triptans in children |
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Advil migraine =
Exedrine migraine = |
Ibuprofen
APAP, ASA, Caffeine ***Some people get relief from these, triptans, or other prescription products such as hydrocodone or other opioid combos or tramadol) |
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What agents are available for prophylaxis?
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Anti-depressants
Anti-convulsants Vitamins, minerals or natural products |
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What natural products exist for migraine?
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Feverfew, Willowbark (a salicylate), Butterbur, Magnesium, and Riboflavin
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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: |
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) |
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Which triptans come in a nasal spray?
Disintegrating tablets? Injection? |
Imitrex (Sumatriptan)
Zolmitriptan (Zomig) Rizatriptan (Maxalt) Zolmitriptan (Zomig) Imitrex (Sumatriptan) |
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Triptan contraindications:
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Cerebrovascular disease
Uncontrolled hypertension Caution with other serotonergic medications |
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Triptans can cause "triptan sensations" - what are these like?
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Pressure on the chest or or neck region and usually dissipate after administration
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Which triptans have a longer half life and can be used if the pain continues after dosing?
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Frovatriptan
Naratriptan |
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A recent study found this:
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Eletriptan (Relpax) to be more effective than Sumatriptan (Imitrex) in relieving pain
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Imitrex - describe how long you must wait to repeat a dose and the max doses:
What is Treximet? |
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 |
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Important to know about zomig nasal spray:
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There is only one dose in the nasal spray - do not prime or you will lose it
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Less commonly used migraine medications:
What is Fioricet? What is Fiorinal? |
APAP/Butalbital/Caffeine - also can come with codeine
ASA/Butalbital/Caffeine |
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Ergotamine products are pregnancy category:
What products are available: |
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) |
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Consider using prophylactic treatments if:
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Patient uses acute treatments more than twice per week if their quality of life is decreased
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First line for migraine prophylaxis:
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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*** |
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What are "rebound" headaches?
What should be done for them? |
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 |