Migraine Flashcards Preview

Pharmacology Test #6 > Migraine > Flashcards

Flashcards in Migraine Deck (62)
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1

Migraine

severe, recurrent, unilaterial throbbing in temples, eye orbits, front of head, with nausea and vomiting

2

Required to terminate most migraine attacks

sleep

3

Symptoms of a migraine include

aura, photophobia, hyperacusis, polyuria, diarrhea, and disturbances in mood and appetite - may occur up to 24 hours before headache

4

Most common comorbidities of migraines

depression, anxiety disorders, stroke, irritable bowel syndrome, epilepsy, and hypertension

5

Migraine trigger factors

1. Dietary factors
2. Food additives
3. Sleep disturbances
4. Emotional factors
5. Environmental factors
6. Hormones cycles or changes
7. Medication Use/Overuse/Withdrawal
8. Excessive exercise

6

Migraine with Aura definition

1. Minimum of 2 attacks
2. Exhibits at least 3 of the following characteristics: gradual onset, mild to severe in intensity; reversible aura, lasts 5-60 min; headache follows aura within 60 min; may or may not have nausea and vomiting; photophobia, phonophobia

7

Migraine without aura definition

1. Minimum 5 attacks lasting 4-72 hours (no aura, stars with headache
2. Any 2 of: unilateral, pulsating, aggravated by routine physical activity, moderate to severe intensity
3. Any 1 of: nausea and vomiting, photophobia and phonophobia

8

Migraine pathophysiology

Vasospasm of cerebral arteries - initial vasoconstriction, then vasodilation; sterile neurogenic perivascular edema and inflammation

9

Drugs that abort migraines are

vasoconstrictors

10

Cortical spreading depression

Elevates extracellular: K+, H+, NO, AA;
Activates TG nociceptors (afferents)

11

TG efferents release:

CGRP, substance P, NKA-

12

5-HT receptors

5-HT(1B), 5-HT(1D), and 5-HT(1F) receptors are highly expressed in the trigeminovascular system

13

5-HT(1B) receptors mediate

vasoconstriction

14

5-HT(1D) receptors likely inhibit

neurotransmitter release

15

5-HT(1F) receptors likely inhibit

release of nociceptive signaling molecules

16

Drugs used to abort migraines

1. Acetominophen
2. Aspirin/NSAIDs
3. Serotonin (5-HT(1B/1D/1F)) agonists

17

Drugs used to prevent migraines

1. beta-adrenergic antagonists
2. Tricyclic antidepressants
3. Anticonvulsants
4. Botulinum Toxin A (Botox)

18

Nonspecific abortive agents

1. Aspirin
2. Acetaminophen (APAP)
3. NSAIDs: ibuprofen, naproxen, ketoprofen, ketolorac
4. Combination therapy with barbiturates, opiates

19

Excedrin Migraine

APAP 250 mg, ASA 250 mg, Caffeine 40 mg
(combination therapy outperformed ibuprofen)

20

Migralam

APAP 250 mg, Caffeine 100 mg, Isometheptene 65 mg
(caffeine dose may cause insomnia)

21

Midran

APAP 325 mg, dichlorophenazone 100 mg, isometheptene 65 mg

22

Fiorinal

butalbital 50 mg, aspirin 325 mg and caffeine 40 mg; with or without codeine 39 mg

23

FioricetR

butalbital 50 mg, APAP 325 mg and caffeine 40 mg; with or without codeine 30 mg

24

Butorphanol

nasal spray

25

Anti-emetics as adjuncts in migraine

Metoclopramide (ReglanR)

26

Metoclopramide (ReglanR)

Dopamine (D2) receptor antagonist; decreases nausea, stimulates gastric emptying, gastric emptying decreased in migraines, improves absorption of antimigraine agents

27

Source of ergot alkaloids

claviceps purpurea growing on rye

28

Contaminated rye flour caused

epidemics of ergot poisoning - gangrenous limbs, psychoses, spontaneous abortions

29

Ergot alkaloids

Ergonovine, serotonin, ergotamine

30

Ergot alkaloids used to abort migraines

Ergotamine and Dihydroergotamine (DHE)