Pharmcology of Migraine Headache

Question 1

Effective medications for the management of many acute migraine attacks

Answer 1

Simple Analgesics and NSAIDs

Question 2

An option when migraine-associated nausea and vomiting are severe

Answer 2

Suppository preparations of simple analgesics and NSAIDs

Question 3

Analgesics that have demonstrated the most consistent evidence of efficacy include

Answer 3

Acetominophen and acetominophen/aspirin/caffeine (excedrin migraine)

Question 4

NSAIDS that have demonstrated the most consistent evidence of efficacy include

Answer 4

Aspirin, Ibuprofen, Naproxen, and Diclofenac

Question 5

Appear to prevent neurogenically-mediated inflammation in the trigeminovascular system by inhibiting cyclooxygenase (COX)-mediated prostaglandin synthesis

Answer 5

Analgesics and NSAIDs

Question 6

Should be avoided or used cautiously in patients with previous ulcer disease, renal disease, or hypersensitivity to aspirin

Answer 6

Analgesics and NSAIDs

Question 7

Migraine-specific medications, and their introduction represented a major advance in migraine pharmacotherapy

Answer 7

Seratonin receptor agonists (triptans)

Question 8

They are appropriate first-line therapy for patients with mild-to-severe migraine, and are used for rescue therapy when non-specific medications (e.g., analgesics and NSAIDS) are ineffective

Answer 8

Triptans

Question 9

The different triptans differ primarily with regard to pharmacokinetics and pharmacodynamics. Slower onset of action and reduced efficacy are seen with

Answer 9

Frovatriptan and Naratriptan

Question 10

That said, frovatriptan and naratriptan also have the longest half-lives and therefore less

Answer 10

Headache recurrence

Question 11

Selective agonists at serotonin 5-HT1B and 5-HT1D receptors

Answer 11

Triptans

Question 12

Relief of migraine is the result of three key actions:

1) Normalization of dilated intracranial arteries through enhanced vasoconstriction.
2) Inhibition of vasoactive peptide release from perivascular trigeminal neurons.
3) Inhibition of transmission through second-order neurons ascending to the thalamus

Answer 12

Triptans

Question 13

What are some of the mild adverse effects of Triptans?

Answer 13

Paresthesias, dizziness, fatigue, and flushing

Question 14

Up to 25% of patients receiving triptans report tightness, pressure, heaviness, or pain in the

Answer 14

Chest, neck, or throat

Question 15

The triptans are partial agonists at 5-HT coronary artery receptors, and are therefore contraindicated in patients with a history of

Answer 15

Ischemic heart disease, uncontrolled hypertension, and cerebrovascular disease

Question 16

The triptans should not be given to patients receiving

Answer 16

SSRIs or SNRIs

Question 17

Can be considered for the treatment of moderate-to severe migraine attacks

-Their use, however, is limited by issues of efficacy and side effects

Answer 17

Ergotamine tartrate and dihydroergotamine

Question 18

Ergotamine is available in oral, sublingual, and rectal preparations, with dihydroergotamine being available for

Answer 18

Intranasal and parenteral administration

Question 19

Non-selective agonists at serotonin 5-HT1 receptors.

-Cause constriction of intracranial blood vessels and inhibit the development of neurogenic inflammation in the trigeminovascular system

Answer 19

Ergot Alkaloids and Derivatives (Ergotamine tartrate and dihydroergotamine)

Question 20

Central inhibition of the trigeminovascular pathway has also been reported with

Answer 20

Ergot Alkaloids and Derivatives (Ergotamine tartrate and dihydroergotamine)

Question 21

Among the most common adverse effects to Ergotamine tartrate and dihydroergotamine

Answer 21

Nausea and vomiting

Question 22

Contraindicated in patients with renal or hepatic failure; coronary, cerebral, or peripheral vascular disease; uncontrolled hypertension, and sepsis

Answer 22

Ergotamine tartrate and dihydroergotamine

Question 23

Ergotamine tartrate and dihydroergotamine are also contraindicated in women who are

Answer 23

Pregnant or nursing

Question 24

Among the most widely used drugs for migraine prophylaxis

Answer 24

B-Adrenergic antagonists (B-blockers)

Question 25

B-Blockers with established efficacy in migraine prophylaxis include:

Answer 25

Metoprolol, Propanolol, and Timolol

Question 26

Although not first-line treatment for hypertension or anxiety, may be useful along with other therapy in patients with comorbid hypertension or angina

Answer 26

B-blockers

Question 27

Adverse effects can include drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression, impotence, bradycardia, and hypotension

Answer 27

B-blockers

Question 28

B-blockers should be used with caution in patients with

Answer 28

CHF or peripheral vascular disease

Question 29

Antidepressants with established efficacy in migraine prophylaxis include the: 1. ) Tricyclic Antidepressant 2. ) SNRI

Answer 29

1. ) Amitriptyline | 2. ) Venlafaxine

Question 30

May be particularly useful in patients with comorbid depression or insomnia

Answer 30

Antidepressants

Question 31

Thought to be related to downregulation of central 5-HT2 receptors, increased levels of synaptic norepinephrine, and enhanced endogenous opioid receptor actions

Answer 31

Antidepressants

Question 32

Anticholinergic side effects are common with -Limit the use of this agent in patients with benign prostatic hyperplasia and glaucoma

Answer 32

Amitriptyline

Question 33

Most common adverse effects with venlafaxine are

Answer 33

Nausea, vomitting, and drowsiness

Question 34

Have emerged as important therapeutic options for migraine prophylaxis, with valproate (Depakene®), divalproex (Depakote®), and topiramate (Topamax®) having established efficacy

Answer 34

Anticonvulsants

Question 35

May be particularly useful in patients with comorbid seizure disorder or bipolar illness

Answer 35

Anticonvulsants

Question 36

The most extensively studied medication for migraine prophylaxis

Answer 36

Topiramate (anticonvulsant)

Question 37

The benefits of topiramate are observed as early as two weeks after initiation of therapy, with significant reductions in migraine frequency within the

Answer 37

Month

Question 38

Thought to function via enhancement of GABA mediated inhibition, modulation of glutamate, and inhibition of Na+ and Ca2+ channel activity

Answer 38

Anticonvulsants

Question 39

Nausea and vomiting are the most common side effects of -These effects are self-limited and are less common with titration of doses

Answer 39

Valproate and Divalproate

Question 40

The most serious side effect of valproate therapy is

Answer 40

Hepatotoxicity

Question 41

Contraindicated in pregnant women (potential for teratogenicity) and patients with a history of pancreatitis or chronic liver disease

Answer 41

Valproate

Question 42

Paresthesia is the most common adverse effect of

Answer 42

Topiramate

Question 43

Should be used with caution or avoided in patients with a history of kidney stones or cognitive impairment

Answer 43

Topiramate

Question 44

Useful for the prevention of migraine headaches that occur in a predictable pattern, such as menstrual migraine

Answer 44

NSAIDs and triptans