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Flashcards in ADHD and Migraine Deck (22):

What is the efficacy of stimulants as a treatment of ADHD?

Treatment with medication or in combination with medication + behavioral therapy is significantly better than behavioral therapy alone (or no intervention either).

However, in the long-term, there is no significant difference in outcomes, and kids tend to function worse than their peers.


What are two stimulants used in the treatment of ADHD and how do they work?

Methylphenidate (Ritalin) and amphetamine (Adderall)

Work by reversing VMAT-2 as well as DAT/NET to cause increase in NE/DA in the synapse


Does D-amphetamine have similar effects in normal people as those with ADHD?

Actually yes - so it's unlikely to be due to a DAT transporter overexpression problem

Reduces activity, inattention, and impulsivity


What is meant by double-pulse administration of stimulants and why does this need to be done?

Short-acting formulation with a long-acting / extended release capsule inside.

Half-life is only 3-5 hours so you would normally need multiple doses in the day

Take in the morning for instant therapeutic effect early in the day, which lasts throughout the day due to XR


What are the adverse effects of the stimulants?

Decreased appetite / weight loss (diet pills)
Delayed sleep onset, insomnia
Anxiety / irritability
Stomach aches / headaches


What is a side effect of concern for children with stimulants?

May cause long-term growth retardation


What drug was originally marked as an antidepressant but is now used less efficaciously against ADHD?


Norepinephrine reuptake inhibitor (NRI)


How is Atomoxetine metabolized?



What are the adverse effects of Atomoxetine?

Nausea, vomiting, and sleepiness

Important warning: Increased suicide risk


What are the alpha-2 agonists which are used for treatment of ADHD and how does this work?

1. Guanfacine
2. Clonidine

Works by inhibiting NT release, thereby strengthening regulation pathways in the prefrontal cortex


What is the last class of drugs used to treat ADHD?

Antidepressants - i.e. bupropion


How is migraine distinguished from other types of headache? What are the other features of migraine?

Presence of prodrome or aura

Generally unilateral
Associated with nausea and vomiting
Intense enough to interrupt daily activities
Can last up to three days untreated


What is the most important way to prevent migraines and who does it disproportionately affect?

Recognize the triggers
Affects women 3x as much as men


What causes the aura in migraine?

Cortical spreading depression (CSD) which is a slowly propagating wave of depolarization across the cortex

-> happens in only a fraction migraines


What is the consensus today about what triggers migraine?

Sensitization of the trigeminal afferents, especially those which supply the area around the cranium. This leads to the activation of nociceptive neurons


What are the drugs of choice for mild-moderate migraine?

NSAIDs or combinations of NSAIDs with codeine / hydrocodone


What are the drugs of choice for moderate-severe migraine? Their mechanism of action?

Triptans - they act as 5-HT1 B/D agonists which are targeted towards presynaptic terminals
-> inhibit neurotransmitter release
-> Inhibit synaptic transmission


When should treatment with triptans begin? Is it a monotherapy?

As early as possible -> prevent the development of full migraine episode, not good for stopping one in full force

Use in combination with an NSAID


What is the prototype triptan and when are they contraindicated?


-contraindicated in arterial disease / uncontrolled hypertension, though there are few side effects


Can triptans cause serotonin syndrome? Why aren't they always used?

Yes, because they are a serotonin receptor agonist

Aren't always used because they are very expensive


What drugs are used to prevent migraine currently?

1. Beta-blockers
2. Anti-epileptics
3. Antidepressants
3. Behavioral therapies (Relaxation, cognitive therapy)


What future drug target might entirely stop migraines from developing?

CGRP - either an anti-CGRP or an antagonist

Calcitonin Gene Related Peptide - Important in development of migraine