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17 Cards in this Set
- Front
- Back
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NSAIDs/OTCs
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1. Excedrin Migraine (Extra Strength Excedrin) 2. Ibuprofen
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Selective Serotonin Agonists (Triptans)
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•Sumatriptan (Imitrex): use nasal/subQ for moderate to severe •Sumatriptan-naproxen combo (Treximet) (85/500) •Almotriptan (Axert) •Eletriptan (Relpax) ovatriptan (Frova) •Naratriptan (Amerge) •Rizatriptan (Maxalt and Maxalt-MLT) •Zolmitriptan (Zomig and Zomig-ZMT)
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Ergotamine tartrate
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Narcotics
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1. Butorphanol (Stadol) 2. Percocet (325/5) 3. Percodan (325/4.5)
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Antiemetics
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1. Metoclopramide (Reglan) 2. Chlorpromazine (Thorazine) 3. Chlorpromazine
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Corticosteroids
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1. Parenteral dexamethasone with triptan 2. Prednisone with taper
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Dihydroergotamine
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DHE-45 (Migranal nasal spray)
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Beta Blockers
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Propanolol
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Antidepressants
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Amitryptyline (Elavil)
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Anticonvulsants
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1. Valproic acid (Depakote) 2. Gabapentin (Neurotonin) 100 mg t.i.d. 3. Topiramate (Topomax) 50 mg b.i.d.
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Migraine without Aura
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70-80% of migraines
HA upon awakening GI upset (less common) Chilled during attack Attack lasts 4-72 hours |
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Migraine with Aura
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Aura: •Teichopsia (flashing lights), •Expanding "fortification"scotomas, or “heat waves”
•Hemianopsias or quadranopsias – respects the midline •Restoration of vision Pain: follows aura after 60 minutes •GI upset with N&V (80%) •Paresthesias, and hemipareses possible •Increased risk for AMI and stroke Aura rarely > 1 hour Total: Lasts from 8 to 72 hours |
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Ophthalmoplegic Migraine
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Children under 12 years (M>F)
Very rare •Boring pain around eye •HA usu precedes ocular involvement •Diplopia, ptosis, mydriasis and EOM involvement •Repeated attacks can result in permanent damage Ocular effects can last for weeks Usually affects CN III (down and out, blown pupil) |
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Retinal Migraine
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Monocular (opposed to other migraine scotomae)
Last about 1 hour and usually followed by the headache Constriction of CRA or ophthalmic artery R/O: TIA (consider age), and vitreoretinal disease |
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Transformed Migraine
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Repeated, episodic migraine increases frequency
Can become daily Usually caused by a lack of treatment early on in the migraines suffering |
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Acephalgic Migraine (Migraine Equivalent)
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Approximately 6.5% of patients >18 in one study
9% of women, 3% of men •Childhood history of motion sickness •Family history of migraine HA •No association with family history of MAWH NOT a retinal migraine |
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Migraines
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Migraine
•Up to 10% of the population •F>M (7:3) •Peak age range: 25-55 •80 - 90% have family history •50 to 80% of pts get prodrome •10-20% of pts get aura •60% unilateral •1-4 times/month •Can occur daily (usu due to improper treatment of the migraine) Reduced threshold for neuronal excitability •GABA not sufficient enough to inhibit glutamate •Genetic predisposition? •Central sensitization (“kindling”) Serotonin depletion and dopamine stimulation Non-Pharm: •Healthy, scheduled lifestyle •Biofeedback •Acupuncture •Magnetic pulse (?) during aura •HA diary (identify triggers) |
