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Flashcards in MIGRAINE Deck (15):
1

MIGRAINE

-a common EPISODIC disorder

-disabling headache generally associated with NAUSEA and/or LIGHT + SOUND SENSITIVITY

-most migraine suffereres require pharmacologic treatment 

2

DRUGS FOR MILD-MODERATE ATTACKS

either = DOC

1) ACETAMINOPHEN

2) NSAIDS

--> for mild-moderate attacks NOT ASSOCIATED with vomiting/severe nausea

3

TRIPTANS

drugs used for MODERATE-SEVERE ATTACKS

TRIPTANS = DOC for moderate-severe migraines

-Triptans are selective agonists at 5-HT1D and 5-HT1B receptors

Combination of sumatriptan and naproxen provides better pain relief than either drug alone.

SC sumatriptan is the fastest-acting and most effective triptan formulation.

ADVERSE EFFECTS:

1) tingling, flushing, dizziness, fatigue

2) Chest tightness

3) RARE: angina, MI, arrhythmia, stroke, and death

CONTRAINDICATIONS: 

-in coronary, cerebrovascular, or other arterial disease, or uncontrolled HTN

4

ERGOTAMINE

DIHYDROERGOTAMINE

ERGOT ALKALOIDS: DRUGS USED TO TREAT MODERATE-SEVERE ATTACKS

ER GROSS AMINE --> agonist at a few receptors, but can cause GANGRENE (er gross) d/t vascular occlusion (contraindicated in arterial disease or uncontrolled HT) 

-Ergotamine acts as an agonist at α-adrenoceptors, 5-HT and D2 receptors

• The agonist actions of ergot alkaloids at 5-HT1B/1D receptors likely mediate their anti-migraine effects.

ADVERSE EFFECTS:

1) Nausea and vomiting. Can be prevented with an antiemetic such as metoclopramide.

2) Serious adverse effects: vascular occlusion and gangrene. Rare. Usually associated with overdosage.

3) Dihydroergotamine is a weaker vasoconstrictor than ergotamine and causes fewer AE.

CONTRAINDICATIONS:

1) arterial disease or 2) uncontrolled hypertension.

5

DRUGS FOR PREVENTOIN OF MIGRAINE

-Patients with frequent or severe disabling migraine headaches should receive prophylactic treatment.

-The mechanisms of action of drugs used for migraine prophylaxis are diverse.

-No single drug has emerged as a clear treatment of choice.

FIRST LINE AGENTS: BETA BLOCKERS, VALPROATE, TOPIRAMATE (Val's at the top with Beta) --> they are the top of the prophylatic choices

SECOND LINE AGENTS: Tricyclic AntiD's, SNRI's, Calcium Channel Blockers, Gabapentin, ACEIs/ARBs, Botulinum Toxin, NSAIDS

6

BETA BLOCKERS

FIRST LINE AGENTS FOR PREVENTION OF MIGRAINS

PROPANOLOL, TIMOLOL, METOPROLOL, NADOLOL, ATENOLOL

--> for continuous prophylaxis, beta blockers are commonly used 

7

VALPROATE

FIRST LINE AGENT FOR PREVENTION OF MIGRAINE

Val (james's girlfriend) may be a little crazy (biopolar, epilepsy), but she sometimes gives him a headache --> she inhibits Na and Ca from his diet --> can strangle him also and give him THROMBOCYTOPENIA

-indicated for BIPOLAR DISORDER, EPILSEPY, + MIGRAINE PROPHYLAXIS

-valproate inhibits voltage gated Na+ channels and T-type Ca2+ channels 

ADVERSE EFFECTS:

-GI side effects, Thrombocytopenia, rarely hepatotoxicity, teratogenic 

8

TOPIRAMATE

FIRST LINE AGENT FOR PREVENTION OF MIGRAINE

Like Val, also used for epilepsy, also blocks Na+ but is a GABA AGONIST, Glut antagonist (unlike val, who works out) --> affects your Top ie your Two eyes --> acute myopia, glaucoma

-indicated for 1) EPILEPSY and 2) MIGRAINE PROPHYLAXIS

-inhibits voltage-gated Na+ channels 

-GABAA receptor agonist and glutamate receptor antagonist.

AE: Somnolence, fatigue, cognitive slowing, nervousness, confusion. Acute myopia (nearsightednes) , glaucoma. Hyperthermia, renal stones. Teratogenic.

 

9

AMITRIPTYLINE

NORTRIPTYLINE

IMIPRAMINE

TRICYCLIC ANTI-D'S: 2ND OR 3RD LINE AGENTS

-are TCAs that inhibit NE or Serotonin reuptake

AE: sedation, dry mouth, weight gain 

10

VENLAFAXINE

SEROTONIN NE RUPTUAKE INHIBITOR (SNRI's): 2nd-3rd line agent

AE: nausea, constipation, insomnia, headaches, sexual dysfunction 

 

11

VERAPAMIL

CALCIUM CHANNEL BLOCKER (2ND OR 3RD LINE AGENT)

-are used for prevention of migraine, but evidence for their effectiveness is WEAK

-Verapamil is the CCB with the most evidence of efficacy 

12

GABAPENTIN

-gabapentin decreases glutamate release by blocking presynaptic voltage-gated Ca2+ channels

GABAPENT --> makes a tent in the presynaptic cleft and BLOCKS the GLUTAMATE RELEASE

AE: sleepiness, dizziness, fatigue (B/C IN A TENT) 

13

LISINOPRIL

CANDESARTAN

2nd/3rd line ACEI's or ARBs

 

Lisinopril and Candesartan have reduced migrine fequency by about 30% 

 

14

BOTULINUM TOXIN

2nd-3rd line prophylactic agent

-pericranial injections of botulinum toxin is marginaly fffective for prophylaxis of headaches in adult patients with chronic migraine (patients with 15 or more headache days/month)

15

NAPROXEN

IBUPROFEN

2ND/3RD LINE AGENT: PROPHYLACTIC USE NSAIDS

1) NAPROXEN

2) IBUPROFEN

--> have been used for short-term pervention of migraine