Migraines

Question 1

What are the main types of drugs used to treat migraines?

Answer 1

1. Triptans (5-HT 1D/1B agonists)
2. Ergot alkaloids
3. Non-steroidal anti-inflammatory analgesics
4. Tricyclic antidepressants (TCA)
5. Selective Serotonin Reuptake Inhibitors (SSRI)
6. Migraine prophylaxis (not for acute)

Question 2

MOA: Vaso constrictor actions, may act on presynaptic terminals to inhibit release of vasodilation peptides; bind to serotonin receptors found on blodvessels in the cerebrum and meninges

Answer 2

Triptans (5-HT 1D/1B agonists)

• sumatriptan = first line
• should not be used for pts at risk for CAD

Question 3

MOA: vasoconstrictor actions; tend to have multiple actions in the NS (alpha receptors, DA receptors, 5-HT receptors); highly specific for migraines;

Answer 3

Ergot alkaloids

Question 4

MOA: inhibit the presynaptic terminals

Answer 4

Anti-seizure medication

Question 5

MOA: control pain

Answer 5

NSAIDS and ibuprofen

Question 6

ADRs of this drug: Altered sensations (warmth, tingling, etc.), Dizziness, Muscle weakness, Neck pain; contraindicated for patients with CAD or angina

Answer 6

Triptans

Question 7

Contraindications for specific triptan: Patients with severe hepatitis or renal impairments, or peripheral vascular syndromes

Answer 7

• Naratriptan

- Eletriptan

Question 8

Contraindications for specific triptan: Patients with peripheral vascular disease

Answer 8

Frovatriptan

Question 9

Contraindications for specific triptan: Patients with Wolff-Parkinson-White Syndrome (Disorder of the electrical conduction system of the heart)

Answer 9

Zolmitriptan

Question 10

What are the different types of triptan

Answer 10

1. Eletriptan
2. Frovatriptan
3. Naratriptan
4. Rizatriptan
5. Sumatriptan
6. Zolmitriptan
7. Almotriptan
   - see ppt for dose, max does, half life

Question 11

What are some concerns for pts taking triptans?

Answer 11

• expensive
• Duration of the drug’s actions often shorter than the duration of the migraine (May require several sequential doses during a prolonged attack; ADRs can limit the maximal safe dose)

Question 12

What are the types of ergot alkaloids

Answer 12

1. Ergotamine

2. Dihydroergotamine

Question 13

Ergot alkaloid: less effective when given past produce (feeling that migraine is going to occur); long half-life can lead to overdose; A: PO, sublingual, rectal suppository, inhaler, IV

Answer 13

Ergotamine

Question 14

Ergot alkaloid: Preferred by come clinicians for intractable migraines; Usually i.v.; Can be intranasally

Answer 14

Dihydroergotamine

Question 15

What are the types of migraine prophylaxis drugs?

Answer 15

1. Propranolol – beta-blocker
2. Amitryptyline – TCA
3. Anti-seizure medications (Topiramate; Valproic acid)
4. Verapamil – Calcium channel blocker
5. Flunarizine – CCB used in Europe

Question 16

Since migraine prophylaxis drugs do not benefit acute migraines and have no affect after they’ve started, what are they used for?

Answer 16

1. Reduces severity of acute attacks

2. Prevent recurrences

Question 17

What other drugs are used migraine attacks?

Answer 17

1. Parenteral opioids for refractory cases
2. Parenteral metoclopramide for severe nausea and vomiting
   Dopamine antagonist