Migraine Drugs

Question 0

Amitriptyline (Elavil)

Answer 0

Tricyclic antidepressant. Used for migraine, tension HA, chronic pn, bipolar d/o, and depression.
MOA - CNS modulation of 5HTP and NE. Can be PO or IM
SFx: Dizziness and drowsiness. Anticholinergic effects like dry mouth, constipation, urinary hesitancy and blurred vision. DO NOT use with MAOI.

Question 1

Propanolol (Inderal)

Answer 1

B-blocker, non-selective. Used for HTN, angina, MI, panic attacks and migraine HA prophylaxis.
MOA - blocks andrenergic stimulation, decreasing HR and also reduces renin release.
SFx: Bronchoconstriction, hupotension, bradycardia, fatigue, impotence, hyperglycemia. Do not abruptly d/c this drug.

Question 2

Topiramate (Topamax)

Answer 2

Anticonvulsant. Used for epilepsy, migraine prophylaxis, off-label for BPD.
MOA - Blocks voltage-gated Na channels modulating the effect of GABA. PO.
SFx: Fatigue, dizziness, vision changes, ACUTE ANGLE GLAUCOMA, nausea, constipation.

Question 3

Methylsergide (Sansert)

Answer 3

Ergot-derivative 5HTP-2 R antagonist. Used for migraine and cluster HA prophylaxis.
MOA - unknown. May be due to vasocontrictive effect. PO. Should NEVER be used longer than 6mo and dosage must be tapered down when discontinuing. DO NOT use within 24h of triptans.
SFx: HTN, thrombophlebitis, N/V, heart valve thickening, pulmonary fibrosis and retroperitoneal fibrosis. CATEGORY X.

Question 4

Sumatriptan (Imitrex)

Answer 4

Triptan class serotonin antagonist. Used for migrain and cluster HA.  
MOA - antagonist of 5HTP receptors 1B and 1D (R found in small peripheral nerves which affect intracranial vasculature. PO, SQ, nasal spray. Onset in 10-60', NO MORE THAN 2 DOSES IN 24h.
SFx: Dizziness, tingling, weakness, chest tightness, arrhythmias, HTN. Category C in pg.

Question 5

Serotonin Syndrome

Answer 5

Uncommon sfx of all triptans. Sxs include agitation, tremor, ataxia, fever, chills and diarrhea. Frequent triptan users are at higher risk (?). No more than 2 doses of any triptan should be used in a 24h period.

Question 6

Butorphanol (Stadol)

Answer 6

Opioid analgesic. User for severe migraines refractory to other tx.
MOA - mixed opioid receptor antagonist / agonist. May be nasal spray or IM. Does is 1 spray per nostril q3-5h for pn control.
SFx: Nasal irritation, drowsiness, dysphoria, N/V, withdrawal sxs in opiate addicted pts, dependence and addiction.

Question 7

Antiemetics for migraines

Answer 7

May use:
Diphenhydramine (Benadryl)
Prochloperazine (Compazine)
Promethazine (Phenergan)
May be PO, IV, PR

Question 8

Prochlorperazine (Compazine)

Answer 8

Typical neuroleptic, used for anti-emesis in migraine pts, vertigo. Also an anti-psychotic.
MOA - H1 histamine receptor antagonist. D2 dopaminergic and alpha-andrenergic receptor antagonist. Given PO, PR, IM or IV.
SFx: Drowsiness, dry mouth, constipation, urinary retention, decreased seizure threshold.