migraines

Question 1

What are the main symptoms of a migraine?

Answer 1

Throbbing pain (mod–severe), nausea, vomiting, photophobia, phonophobia.

Question 2

Are migraines debilitating?

Answer 2

Yes, they can be very debilitating.

Question 3

What often influences migraine occurrence?

Answer 3

Hormonal changes and family history.

Question 4

What are the two primary forms of migraines?

Answer 4

Migraine with aura and migraine without aura.

Question 5

Emotions

Answer 5

Stress, anxiety.

Question 6

Foods

Answer 6

Tyramine (aged cheese, red wine), nitrates (cured meats), chocolate, MSG (canned soup, Chinese food), aspartame (diet sodas), yellow food dye.

Question 7

Drugs

Answer 7

Alcohol, overused analgesics, caffeine (too much or withdrawal), cimetidine, cocaine, estrogens (e.g., OCPs), nitroglycerin.

Question 8

Environmental

Answer 8

Flickering lights, loud noise, weather changes (humidity, temperature, barometric pressure).

Question 9

Other

Answer 9

Hypoglycemia, altitude change.

Question 10

What are the two treatment strategies for migraines?

Answer 10

Prevent attacks and abort ongoing attacks.

Question 11

What drugs are used to abort a migraine?

Answer 11

Nonspecific analgesics (ASA-like drugs, opioids), and migraine-specific drugs (Triptans and Ergot alkaloids).

Question 12

When is prevention recommended?

Answer 12

If the patient has 3 or more migraines per month.

Question 13

What are nonpharmacologic methods for prevention?

Answer 13

Avoiding triggers, lifestyle changes, headache diary, relaxation exercises.

Question 14

sumatriptan [Imitrex]

Answer 14

Causes vasoconstriction & reduces inflammation; aborts migraine; PO or intranasal.

Question 15

AEs of sumatriptan

Answer 15

Chest symptoms (50%), coronary vasospasm, teratogenicity, vertigo, malaise, fatigue, tingling, bad taste (nasal).

Question 16

Other Triptans

Answer 16

naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova), eletriptan (Relpax).

Question 17

Ergotamine

Answer 17

2nd line treatment for migraines that don’t respond to triptans.

Question 18

Risk with regular use

Answer 18

Physical dependence.

Question 19

Toxicity – Ergotism

Answer 19

Convulsive (N/V/D, itching, spasms, paresthesia, HA, mania, psychosis, seizures) or gangrenous (vasoconstriction: finger/toe damage, edema, loss of sensation, possible tissue death).

Question 20

What types of drugs are used for migraine prevention?

Answer 20

Drugs from many different classes.

Question 21

What lifestyle adjustments help prevent migraines?

Answer 21

Avoiding triggers, using a headache diary, relaxation techniques, and regular routines.