What are the Four phases of a typical migraine?
- The prodrome
- The aura
- The headache
- The postdrome
What are nonpharmacological TX for HA?
- Ice to head w/ period of rest and sleep in dark/quiet environment
- Avoid triggers
- Behavioral interventions
What is the difference between the ACP-ASIM 1st LINE TX and USHC 1st LINE TX?
ACP-ASIM features NSAIDs/Combo first and a Step-therapy, whereas USHC features a Stratified therapy
What is considered Non-specific Drug therapy for HA?
What is considered Migraine-specific Drug TX?
- Ergot derivatives
- Triptans (selective 5-HT1B/1D agonist)
What NSAIDs TX are considered for migraines?
1st LINE for MILD to MODERATE migraines
Why would intranasal Lidocaine be considered for treatment of migraines?
Can numb sinus cavities
What Opioids are utilized for TX migraine HA?
Butorphanol (reserved for SEVERE migraine HA that are unresponsive to other treatment)
What barbituates are utilized for Migraine HA?
Butalbital (combined with analgesics or codeine) cause depressant effect on CNS for MODERATE to SEVERE migraines
How do Antiemetics function for TX Migraine HA?
Commonly used as adjuncts (DEC N/V) but also used as monotherapy for migraine TX
- Metoclopramide (IV)
- Chlorpromazine (IV/IM)
- Prochlorperazine (IV/IM)
How do Ergot Alkaloids function?
5-HT1 agonist; activity at alpha/beta adrenergic and D receptors
- constrict intracranial blood vessels
- inhibit neurogenic inflammation in the trigeminovascular system
What are ADRs (Acute) associated with Ergot Alkaloids?
- N/V (pre-treat w/ antiemetics)
- Abdominal pain
- Leg cramps
- Intermittent claudication
Syndrome of ergotism
What may be observed in Syndrome of ergotism?
- Peripheral ischemia
- Numb extremities
- Diminished peripheral pulses
What are ADRs (chronic) associated with Ergot Alkaloids?
- Cerebral/Peripheral ischemia disorders
- Medication overuse HA
- Renal disorders
- Withdrawal signs
What are contraindications of Ergot Alkaloids?
- Renal/hepatic failure
- Peptic ulcer disease
- Uncontrolled HTN
- Potential interactions with protease inhibitors
- Use of Triptans with 24 hrs (addictive vasoconstrictive effects)
How do Triptans function for migraine TX?
Selective 5-HT agonists cause (1st LINE for MODERATE to SEVERE migraine TX):
- Intracranial vasoconstriction
- Inhibit neuropeptide release from trigeminovascular nerves
- Interrupt pain signal within brain stem (trigeminal nuclei)
What medications are classified as Triptans?
What are ADRs associated with Triptans?
- Chest tightness/pressure/heaviness
- Injection reaction
Taste perversion (nasal spray)
What are drug interactions with Triptans?
MAOI (inhibit clearance)
Ergotamine-containing products (INC vasconstrictive effects)
RISK OF SEROTONIN SYNDROME
What is Serotonin syndrome observed as?
- Muscle rigidity
- Rapid change in mental status and vitals
What beta-blockers are utilized in prophylactic TX Migraine?
What tricyclic antidepressants are utilized in prophylactic TX migraine?
What Anticonvulsants are utilized in prophylactic TX migraine?
How does Methysergide function in prophylactic TX migraine?
Peripheral 5-HT inhibitor and central 5-HT agonist
(ADR: Fatal pulmonary fibrosis)
How does Botulinum function in Prophylactic TX migraine?
Inhibits ACh release at presynaptic junction (possible modulator of Substance P)