Migranes

Question 1

Two types of Migraines

Answer 1

• Common WITHOUT aura

- Classic WITH aura

Question 2

What is aura due to?

Answer 2

Reduced blood flow of the posterior part of the brain

Question 3

What is the pain in migraines due to?

Answer 3

Extra and intracranial arterial dilation and release of neuroactive molecules such as substance P

Question 4

What are the two phases of a migraine?

Answer 4

1 - Vasoconstriction

2 - Vasodilation and pulsaiton

Question 5

5HT Agonists (4)

Answer 5

• Sumatriptan
• All other triptans
• Ergotamine
• Dihydroergotamine

Question 6

Sumatriptan MOA (3)

Answer 6

• 5HT1D agonist on small peripheral nerves
• Probably suppresses release of sensory neuropeptides
• Vasoconstriction not as strong as with ergotamine

Question 7

Sumatriptan Admin and t 1/2

Answer 7

• PO or SC

- 2hrs (if HA recurs within 24-48 hrs, 2nd dose req)

Question 8

Sumatriptan SE (5)

Answer 8

• Coronary artery vasospasm, rare cardiac arrhythmias, angina, transient myocardial ischemia, MI, cardiac arrest
• Cerebral vasospasm resulting in intracranial bleeding, subarachnoid hemorrhage, stroke, seizures
• Peripheral vascular ischemia and bowel ischemia
• Abd pain, bloody diarrhea, cramp
• Dizziness, lightheadedness, weakness, myalgia, muscle cramps

Question 9

Sumatriptan CI

Answer 9

• Breast feeding
• Pregnancy
• Cardiac dz, CAD
• Cerebrovasc dz
• DM
• HTN
• IV admin
• PVD
• Renal impairment
• Seizures
• Tobacco smoking

Question 10

Ergotamine MOA (3)

Answer 10

• Acts on 5HT receptors
• Less specific than Sumatriptan
• Caffeine increases absorption and potentiates effects

Question 11

Ergotamine Admin

Answer 11

• Oral
• SL
• Rectal
• Nasal

Question 12

Ergotamine SE (2)

Answer 12

Due to vasoconstriction

• Acute: D/N/V, cardio tox (like sumatriptan)
• Chronic: ergotism - vasoconstrition + CNS

Question 13

Dihydroergotamine MOA

Answer 13

• 5HT agonist

Question 14

Dihydroergotamine Admin

Answer 14

• IV

Question 15

Dihydroergotamine SE (1)

Answer 15

• Nausea

Question 16

Analgesics

Answer 16

• Treat pain
• Aspirin
• Acetaminophen
• Naproxen

Question 17

Prophylaxis of Migraine (8)

Answer 17

• BB (Propranolol)
• CCB (Verapamil)
• Antidepressants (Amitriptyline, Fluoxetine)
• Clonidine
• Valproic Acid
• Topiramate
• Botulism Toxin A and B
• Angiotensin II receptor blockers