Migraines

Question 1

What are the two 5-HT agonists that can be used to treat migraines?
What receptors do they bind to?

Answer 1

1) Sumatriptan
2) Zolmitriptan

1B/1D agonists

Question 2

Lasmiditan, a specific serotonin 5-HT agonist used for migraine is a ___ agonist

Answer 2

1F

Question 3

What drug is an ergot alkaloid (non-specific 5-HT agonist)?

Answer 3

Dihydoergotamine

Question 4

What are the three dopamine antagonists (aka antiemetics)?

Answer 4

1) Metoclopramide
2) Prochlorperazine
3) Chloropromazine

Question 5

What are the five classes of drugs used as prophylactic drug therapy for migraines?

Answer 5

1) Beta blockers
2) Anti-depressants
3) Anti-convulsants
4) Calcitonin gene-related peptide ligand/receptor antagonist
5) Botox

Question 6

True or False: There is increased GI motility that occurs during a migraine.

Answer 6

False - there is decreased GI motility that occurs during a migraine (caffeine helps to increase motility!)

Question 7

A common migraine is a migraine without an ____ while a classic migraine is a migraine with an ____

Answer 7

aura

Question 8

What is a common aura?

Answer 8

Fortification spectrum (visual disturbance)

Question 9

Phases of a migraine?

Answer 9

1) Prodrome
2) Aura
3) Headache
4) Postdrome

Question 10

During what phase of a migraine is there a progression from a dull ache to intense pulsations?

Answer 10

Headache

Question 11

According to the Vascular Theory, why do aura arise?

Answer 11

Vasoconstriction of blood vessels prior to vasodilation

Question 12

What causes the pain of a migraine?

Answer 12

dilation of intracranial blood vessels which activates trigeminal ganglion and registers as pain to CNS

Question 13

True or False: IV injection of 5-HT can aport a spontaneous or drug-induced migraine

Answer 13

True

Question 14

If you have three or more migraines per week, what type of therapy is required?

Answer 14

Prophylactic Migraine Therapy

Question 15

What is the last resort migraine drug?

Answer 15

Butorphanol nasal spray

Question 16

First line migraine drug?

Answer 16

-tryptans

Question 17

If one goes to the ER for a migraine, what med combo will they be given?

Answer 17

IV NSAID + metoclopramide (nausea)

Question 18

If IV NSAID + metoclopramide do not work at the ER, what can be tried?

Answer 18

dihydroergotamine + metoclopramide (nausea)

Question 19

If dihydroergotamine + metoclopramide (nausea) does not work at the ER, what’s tried?

Answer 19

Dexamethasone + metoclopramide (nausea)

Question 20

Combination analgesics, opiates, ergotamine, and triptans are associated with ___________

Answer 20

rebound headaches

Question 21

How can you avoid the problem of rebound headaches?

Answer 21

Abortive therapy should be used ~2 x a week

Question 22

____ is the only medication useful for treating medication overuse headaches?

Answer 22

Botox

Question 23

What types of abortive drug therapy is thought to work by blocking prostaglandin synthesis and preventing inflammation of the trigeminovascular system

Answer 23

NSAID’s

Question 24

What drug can treat the photophobia and phonophobia associated with migraines?

Answer 24

Acetaminophen (Tylenol)

Question 25

What three components is found in Prodrin?

Answer 25

Caffeine, acetaminophen, and isometheptene (vasoconstrictor)

Question 26

What is the benefit of adding caffeine to ergot alkaloid containing products?

Answer 26

Improves intestinal absorption/potentiate vasoconstriction

Question 27

Ergot alkaloids are very good _________

Answer 27

vasoconstrictors

Question 28

_____ is a dirty drug that interacts with serotonin, dopamine, and adrenergic receptors (note: can act as serotonin, adrenergic, or dopamine agonist)

Answer 28

Ergotamine

Question 29

How do ergot alkaloids, such as ergotamine, act?

Answer 29

Activate 5-HT 1B receptors, causing vasoconstriction Activate 5-HT 1D (inhibit production of calcitonin related gene product, NKA, and substance P - all of which are pro-inflammatory cytokines)

Question 30

Can ergot alkaloids be used during pregnancy?

Answer 30

No (schedule X)

Question 31

Why can people get nausea with ergot alkaloid use?

Answer 31

Activates dopamine receptors in chemoreceptor trigger zone

Question 32

Why is dihydroergotamine used over ergotamine?

Answer 32

Causes less vasospasm

Question 33

What class of drugs is metabolized by MAO-A

Answer 33

Triptans

Question 34

Contraindications for triptans?

Answer 34

People taking MAO inhibitors

Question 35

Sumatriptan is an agonist at _____ serotonin receptors

Answer 35

type 1 (more specific than ergot alkaloids)

Question 36

What three drugs act on both 5-HT1B and 5-HT1D?

Answer 36

Sumatriptin, Ergot Alkaloids, and Zolmitriptin

Question 37

True or False: The calcitonin gene-related product can directly cause vasodilation. Therefore, by inhibiting it, you prevent vasodilation

Answer 37

True