Term
| How does a migraine progress? |
|
Definition
| Trigger Event -> Cortical spreading depression -> Activation of Trigeminal fibers on blood vessels -> Meningeal Inflammation -> Activation of Trigeminal Sensory fibers ->Activation of Superior Salivatory Nucleus neurons -> Activation of sphenopalatine neurons -> Parasympathetic response -> more Meningeal Inflammation |
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|
Term
| What causes the pain in migraine? |
|
Definition
| Activation of Trigeminal Sensory Fibers |
|
|
Term
| What causes the pain in migraine? |
|
Definition
| Activation of Trigeminal Sensory Fibers |
|
|
Term
| What causes Cortical Spreading depression? |
|
Definition
| Release of H+, K+, arachidonic acid and nitric osice into cortical tissue |
|
|
Term
| What drugs are used for mild-moderate acute migraine? |
|
Definition
|
|
Term
| What drugs are best for severe acute migraine? |
|
Definition
Triptans or DHEs
Triptans:
Naratriptan, Sumatriptan
DHEs:
Dihydroergotamine |
|
|
Term
| What causes extravasation in a migraine attack? |
|
Definition
|
|
Term
| What causes Vasodiliation in a migraine attack? |
|
Definition
Neurokinin A
Calcitonin Gene-related Peptide
Pituitary Adenylate Cyclase Activating Protein |
|
|
Term
| What drugs reduce Extravasation? |
|
Definition
Serotonin Drugs
Opioids
Somatostatins
NSAIDs |
|
|
Term
| What receptors are targets for reducing vasodilation? |
|
Definition
|
|
Term
| How is CGRP modulated by Serotonin 1D agonists? |
|
Definition
| prevents release of CGRP from nerve synapse |
|
|
Term
| What Serotonin receptors are on the nerve synapse? |
|
Definition
|
|
Term
| What Serotonin receptors are on the vasculature? |
|
Definition
|
|
Term
| What NSAIDs are used for treatment of Acute Migraine? |
|
Definition
Aspirin ASA
Ibuprofen
naproxen |
|
|
Term
| When are NSAIDs most effective for migraine treatment? |
|
Definition
|
|
Term
| What type of NSAID combinations are used? |
|
Definition
| Acetaminophen or Aspirin, butalbital, caffeine |
|
|
Term
| What drug used in NSAID combinations is strongly linked to analgesic overuse syndrome? |
|
Definition
|
|
Term
|
Definition
Barbiturate
Sedative-hypnotic effects via thalamic GABA enhancement
Enzyme inducer; CNS respiratory depressant |
|
|
Term
| What are the Serotonin 5-HT 1B and 1D agonists? |
|
Definition
Triptans:
Sumatriptan
Naratriptan |
|
|
Term
| What is the mechanism of the Triptans? |
|
Definition
Selective intracranial/extracerebral vasoconstriction
Inhibition of Trigeminal nerve activation by vasoactive peptides
Inhibition of trigeminal cervical complex activation |
|
|
Term
| What is the 1st line therapy for moderate/severe migraines? |
|
Definition
|
|
Term
| What Triptan has the longest half life? |
|
Definition
|
|
Term
| What triptan has the most favorable adverse event profile? |
|
Definition
|
|
Term
| Which Triptan doesn't cross the BBB? |
|
Definition
|
|
Term
| What are the contraindications for Triptans? |
|
Definition
Coronary or peripheral vascular disease
uncontrolled HTN or ischemic bowel disease
Use with Ergot alkaloids
MAO and CYP inhibitors |
|
|
Term
| What type of drugs are associated with moldy grains and baked goods? |
|
Definition
|
|
Term
| What do Ergots (Dihydroergotamine) have agonist effects on? |
|
Definition
|
|
Term
| What is Dihydroergotamine contraindicated in? |
|
Definition
Vasospastic predisposition- (vascular disease, MI, HTN)
SSRIs
HIV drugs
Azoles
Pregnancy |
|
|
Term
| What effects can high doses of Ergots have? |
|
Definition
|
|
Term
| What can chronic Ergot use cause? |
|
Definition
|
|
Term
| What are some potential drug interactions of Ergots? |
|
Definition
Triptans
Sympathomimetic vasoconstrictors
Propranolol - blocks vasodilation
Antagonizes nitrates, B-Blockers, CCB
Tobacco |
|
|
Term
| What is the treatment for migraine in pregnancy? |
|
Definition
1st trimester - acetaminophen
Opioids may be added in later trimesters |
|
|
Term
| What common effect of opiates can be relieved by promethazine? |
|
Definition
|
|
Term
| What can contribute to stimulation of the Vomit Center? |
|
Definition
Chemo Trigger Zone - 4th Ventricle
Labyrinth - inner ear
Cortex
Peripheral Pain Receptors
Chemo and Baroreceptors |
|
|
Term
| How long should a 1st line drug be tried before choosing an alternative? |
|
Definition
| 2-3 months with dosage adjustment |
|
|
Term
| What drug is proven effective for migraine prophylaxis in children? |
|
Definition
|
|
Term
| What are the characteristics of Analgesic Overuse Syndrome? |
|
Definition
1. Headache >15 days/month
2. Medication overuse >3months
(Ergots, triptans, opioids >10days/month)
(simple analgesics >15days/month)
3. Headaches got worse while on medication
4. Headache resolve or reverts within 2 months after discontinuing |
|
|
Term
| What is the mechanism of Analgesic overuse syndrome? |
|
Definition
Trigeminovascular system sensitization
Reduced 5-HT levels
Cellular adaptation
Free radical damage in periaqueductal grey |
|
|
Term
| What drugs have a high risk of AOS development? |
|
Definition
Aspirin/Acetaminophen/Caffeine
Butalbital-containing combinations
Opioids |
|
|
Term
| What drugs have a low risk of developing AOS? |
|
Definition
Long-acting NSAIDs
Dihydroergotamine |
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