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Flashcards in Lec 66 Drugs to treat headaches Deck (26)
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1

What are classic prodrome symptoms of migraine?

mood change, fatigue, muscle tension, yawning, cognitive dysfunction

2

What is mech of neurogenic inflammation

trigeminal nerve activation --> release of CGRP/substance P/neurokinin A causes vasodilation, mast cell degranulation --> neurogenic inflammation within meninges --> pain

3

What is use of NSAIDs in migraine treatment?

non-specific acute treatment
efficacy comparable to oral triptans
dosing limited due to concern for renal toxicity
non-sedating
no increase in nausea
safe in presence of vascular disease

4

What is use of neuroleptics in migraine treatment?

D2 antagonist to treat headache pain and migraine-associated nausea

5

Why shouldnt you treat migraine with opioids?

poor efficacy/paradoxical increased pain sensitivity b/c:

- pro inflammatory [degranulate mast cell], vasodilator, activate opioid receptors
- drug seeking behavior
- increase N/V
- poor efficacy

6

What is role of dopamine in migraine?

- prodomal symptoms are due to DA activation

7

What is effect of DA antagonists in migraine? side effects?

- antiemetic
- sedative

side effects = sedation and orthostatic hypotension

ex. metoclopramide

8

What are some names of D2 antagonists that are used to treat migraines?

given IV usually
- cholopromazine
- prochlorperazine
- droperidol
- metoclopramide

9

What are advantages/disadvantages of neuroleptics as migraine treatment?

- effective IV, reduce N/V

side effects:
- sedation, prolonged QT, orthostatic HTN,
extrapyramidal effects [dyskinesia]

10

dihydroergotamine: use, mech, effects, other

use: specific acute treatment to stop migraine

mech: agonist to 5HT-1D receptor

effects: vasoconstriction, nausea

contraindications: vascular disease, HTN, renal/hepatic failure, pregnancy

other: less specific for 5HT receptor compared with triptans

11

How does giving 5HT effect migraine?

IV 5HT relieves migraine but intolerable side effects

12

triptans use, mech, effects, other

use:

mech: 5HT1B/D (and some 1G) receptor agonist

effects:

other

13

What are the 3 mechs of action triptans in improving migraine symptoms?

- intracranial vessel vasoconstriction [5HT1B]
- peripheral neuronal inhibition [5HT1D]
- presynaptic dorsal horn stimulation [5HT1D] causes 2nd order brainstem neuronal inhibition

14

What are effects of triptan?

- reduce all aspects of migraine disability
- minimal or no sedation
- intrinsic antiemetic properties

15

What is use of opioids in migraine treatment?

emergency/rescue treatment

16

What is clinical triad of serotonin syndrome?

- mental status change
- autonomic hyperactivity [HTN, fever, shivering, diarrhea]
- neuromuscular abnormality [myoclonus, ataxia, hyperreflexia]

17

When should you consider preventative migraine treatment?

- headache freq > 6 per month
- headahce disability too often
- acute meds inneffective or contraindicated
- prolonged migraine aura or profound disability

18

What is mech of migraine prevention?

- raise threshold for migraine activation [inhibit CSD, sensitization, neurogenic inflammation]
- stabilize more reactive nervous system

19

What is use of antiepileptic drugs as migraine prophylaxis? which drugs?

valproate and topiramate

20

valproate: use, mech, effects, other

use: migraine prophylaxis or epilepsy

mech: block Na channels

effects: nausea, weight gain, tremor, alopecia, encephalopathy, hepatitis, pancreatitis

other: contraindicated in pregnancy

21

topiramate: use, mech, effects, other

Use: migraine prophylaxis or epilepsy

mech: block Na/Ca, increase GABA-A

effects:

other:

22

What should you use to treat pt with bipolar disorder and migraine?

valproate

23

What is effect of propanolol in migraine?

beta blocker = prophylaxis for migraine

24

How is efficacy of antidepressants as migraine treatment affected by presence/absence of depression?

not affected!

25

What is role of ca-channel antagonists in migraine?

exact mech uncertain
verapmil = L-type Ca channel blocker = most commonly used
may be good for migraine with prolonged aura or vestibular migraine

26

Onabotulinum toxin A: use, mech

Use: chronic migraine prophylaxis

mech: Inhibits release Ach at NMJ, blocks peripheral sensitization