Migraine Nguyen

Question 1

What age range are migraine patients?

Answer 1

18-50 years

Question 2

Which gender is more affected by migraines?

Answer 2

Women

Question 3

What are the criteria for migraine diagnosis?

Answer 3

2 of these: unilateral pain, throbbing pain, pain worsened by movement, moderate or severe pain
1 of these: N/V, photophobia, phonophobia

Question 4

What are the phases/stages of a migraine attack?

Answer 4

1. Prodrome: mood change, difficulty concentrating, phonophobia, photophobia, food cravings, yawning, fatigue
2. Aura
3. Headache
4. Postdrome: drained, fatigued, aching muscles, slow movements, thinking

Question 5

What classes of medications are available for abortive migraine therapy?

Answer 5

triptans, ergot alkaloids, analgesics, combo products, antiemetics

Question 6

Which triptans are available as nasal spray? What is the benefit of a nasal spray?

Answer 6

Sumatriptan, Zolmitriptan

Benefit: faster acting

Question 7

Which triptans are available as nasal spray? What is the benefit of a nasal spray?

Answer 7

Sumatriptan, Zolmitriptan

Benefit: faster acting

Question 8

Which triptans are available as injection? What is the benefit of injection?

Answer 8

Sumatriptan (Imitrex)

Benefit: fast

Question 9

Why might oral absorption be compromised in some migraine patients? (2)

Answer 9

Poor absorption secondary to migraine-induced gastric stasis

N/V induced by migraine

Question 10

Sumatriptan is available in what formulations?

Answer 10

injectable, nasal spray, oral

Question 11

Which triptan has fastest onset?

Answer 11

sumatriptan injectable or nasal

Question 12

Which triptan is the most long acting? 2nd longest acting?

Answer 12

Frovatriptan, Naratriptan

Question 13

Why are triptans preferred over ergots?

Answer 13

Ergots give extreme N/V and risk of severe ADE pulmonary fibrosis, better tolerated than ergots

Question 14

Counsel a patient on how to take a triptan

Answer 14

Tell them to keep a diary
Early treatment within 20-30 min of HA onset
cardiovascular precaution and serotonin syndrome
too much => make headache worse

Question 15

Counsel a patient on the serious side effects of triptans

Answer 15

Cardiovascular precaution and serotonin syndrome

Question 16

Which analgesics are recommended as migraine abortive therapy?

Answer 16

Ibuprofen, Naproxen, APAP

Question 17

Are opioids recommended as migraine abortive therapy?

Answer 17

No

Question 18

Are butalbital containing treatments recommended as migraine abortive therapy?

Answer 18

No

Question 19

What agents are used as abortive migraine therapies in emergency department settings?

Answer 19

IV metoclopramide

IV prochlorperazine + IV dephenhydramine

Question 20

Which of the following are recommended for abortive migraine treatment?

Answer 20

These: triptans, ergot alkaloids, analgesics, combo products, antiemetics
NOT: opioids, fiorinal & fioricet butalbital-containing products

Question 21

When would you start preventive migraine therapy? List 3 scenarios

Answer 21

1. > 4 month
2. Longer than 12 hours
3. Not frequent, but when it happens, it’s bad.

Question 22

What are the 5 main medication classes that may be used in preventive migraine therapy?

Answer 22

Anticonvulsants, antidepressants

b blockers, calcium channel antagonists

Question 23

List 2 examples of AEDs used in migraine patients

Answer 23

valproate

topiramate

Question 24

List 2 examples of TCAs used in migraine PX

Answer 24

amitriptyline/nortriptyline

SNRI/SSRI

Question 25

List 2 examples of B blockers used in migraine PX

Answer 25

propranolol, metoproloo, atenolol, timolo, nadolol

Question 26

Which preventive migraine therapy would be avoided in a patient with severe asthma and why?

Answer 26

Beta blockers

Question 27

Which preventive migraine therapy(s) would be avoided in patient with severe bradycardia?

Answer 27

beta blocker

Question 28

Which preventive migraine therapy would be avoided in a patient with prior history of kidney stones?

Answer 28

AEDs

Question 29

Which preventive migraine therapy would be avoided in a patient who is severely obese?

Answer 29

AEDs, TCAs

Question 30

Which medications are FDA approved for migraine? (4)

Answer 30

valproate, topiramate, propranolol, timolol

Question 31

Which class of preventive migraine therapy would be best in a patient with hypertension?

Answer 31

Beta blocker

Question 32

Which class of preventive migraine therapy would you use in a patient with depression?

Answer 32

TCAs

Question 33

Which class of preventive migraine therapy would you use in a patient with insomnia?

Answer 33

TCAs

Question 34

Which preventive migraine therapy would you use in an overweight patient?

Answer 34

idk

Question 35

Which class of preventive migraine therapy would you use in a patient with epilepsy?

Answer 35

AEDs