Lecture 2 - migraines, triptans Flashcards Preview

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Flashcards in Lecture 2 - migraines, triptans Deck (15):
1

migraines --
Pattern
symptoms
(what are the autonomic symptoms)

Acute and recurrent

Ha, Autonomic sensitivity (N, V, photophobia, phonophobia)

2

three types of true migraines


general treatment for migraines
what is the exception

Migraine with aura (10%) -- aura precedes the HA
Tx - triptans

Migraine without aura (85%) -- no aura, but may have another prodrome (eg yawn)
Tx -Triptans

Complicated migraines
Cannot treat with triptans

3

4 types of complicated migraines

Hemiplegic migraine
Ophthalmoplegic Migraine
Basilar Artery Migraine
Alice in Wonderland Syndrome

4

Tension type HA
- pattern and symptoms
- considerations for treatment

Acute and recurrent HA, but without Autonomic Sx

Can be "mixed" with true migraine

Treatment with triptans only if mixed

5

goal of for treating migraines

Treating migraine is a race against the clock to prevent cutaneous allodynia

6

Pathophysiology of migraines

genetic susceptibility

Triggers -- internal or external

Decreases in Serotonin from the Median Dorsal Raphe Nucleus and Trigeminal Vascular System

which leads to opening of the 5HT1D receptor -- release of inflammatory mediators (PGE, histamines, bradykinin)

leads to meningeal inflammation

7

3 drugs which can be used to treat migraines in the acute setting

• prostaglandin inhibitors
• antihistamines

5ht Agonists -- Triptans

8

Mechanism of Triptans;

name a few

• Mimic Serotonin; Close the gate of inflammatory release upon Serotonin Drop and and stop the headache if you catch it early enough


Sumatriptan
Zolmitriptan
Rizatriptan
Naratriptan
Dihydroergoatamine

9

Prevention of migraines

adjunct therapies

Avoid triggers
SSRIs, TCAs, Calcium Channel Blockers, Anticonsulvants


Anti-Emetics:
Anxiolytics:

10

assessment of migraine pt:
what is SNOOP?

SNOOP -- red flag symptoms that would indicate dx other than migraine. Requires MRI

- Systemic sx: weight loss
- neurologic sx :
- Onset abrupt
- older pt at onset
- Previous HA history is different

11

Secondary HA causes:

what is the most common reason for HA

Tumor, HTN, Infection, Hemorrhage

Infection = most common reason for HA

12

of the secondary causes: which have a chronic progressive pattern vs acute onset pattern

Chronic progressive:
Tumor (worse in the AM, worse with valsalva)

HTN (malignant HTN)

Acute:
Hemorrhage (thunderclap)

Infection -- meningitis, encephalitis

13

what is the most common dx of patients in a HA clinic population

30-80% have chronic daily HA

14

criteria for Chronic daily HA

>15 HA/month
>4 hours/day
Normal MRI

15

three types of chronic daily HA

- patterns for each
which is the hardest to treat

Transformed Migraine -- CHD which develops acute and recurrent pattern

Chronic Tension Type HA -patients with tension type HA that is now chronic
No migraine spikes

- new persistent daily HA- a new HA that doesn't go away
hardest to treat