Term
| What are the most common symptoms associated with migraines |
|
Definition
Photophobia
Phonophobia
Nausea, Vomiting
Osmophobia
Aura |
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Term
| What are the contemporary theories on the pathophysiology of migraines? |
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Definition
Cortical depolarization causes overactivation of CGRP and Substance P neurons that activate the trigeminal nuclues, which conveys the signal to the thalamus and on to the sensory cortex
Raphe and Locus and PAG abnormally trigger cortical depression to activate the trigeminal nucleus, which is conveyed to the thalamus and on to the cortex |
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Term
| What is the main mechanism of agents used in the abortive treatment of migraines |
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Definition
| Inhibit release of peptides and neurotransmitters such as CGRP, and Substance P |
|
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Term
| What are the various agents used in acute therapy of a migraine |
|
Definition
Anti-psychotics
NSAIDs
Narcotics
Combo Analgesics
Triptans
Ergots |
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Term
| What is the mechanism of Triptans |
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Definition
| Presynaptic 5HT-1B/D Agonists blocking Vasoactive peptide release on first and second order neurons |
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Term
| What are the adverse effects and contraindications of triptans |
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Definition
Adverse: Somnolence
Chest Tightness
Contraindicated in any pateint with a CV risk factor
Contraindicated with: MAO-Is, Within 24hrs of Ergots or Methylsergide |
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Term
| What is the mechanism of Dihydroergotamine |
|
Definition
| 5HT1D, and some 5HT2A/B/C, Dopamine, Alpha agonism |
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Term
| What are methods to prevent drug loss from vomiting with dihydroergotamine use |
|
Definition
Rectal
Metocloromide(anti-emetic) |
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Term
| What are the effects of excessive dosing of dyhydroergotamine? |
|
Definition
Cerebral Vasocontriction
Rebound Headaches |
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Term
| What are the contraindications to dihydroergotamine use |
|
Definition
| Beta block bc causes peripheral ischemia |
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Term
| What are the considerations for chosing between dihydroergotamine and triptans? |
|
Definition
Triptans more effective and less sides
Dihydroergotamines are longer acting |
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Term
| What are the drugs used for migraine prophylaxis and when each would be indicated |
|
Definition
Beta Block: HPTN, Angina, Performance anxiety, Aggressive
Calcium Channel Block: HPTN, Hemiplegic
Tricyclics(Amitriptyline, Nortriptyline): Depression, anxiety, panic, fibromyalgia
AntiEpileptics(Topiramate): Overweight, Bipolar
Antiserotonin(Methylsergide): not used(fibrosis) |
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Term
| What is the proposed mechanism of each prophylactic medication used to treat migraines |
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Definition
Beta Block: Membrane stabilizing, decrease prostaglandin
Calcium Channel Block: regulate neurotransmission
Antidepressant: 5HT/Norepi reuptake block, NMDA agonist blocking sensitization
Topiramate: block AMPA, Sodium, and Gaba-A agonist
Valproate: block T-type Ca and Sodium |
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Term
| Drugs used to treat a cluster headache? |
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Definition
O2
Sumatriptan
DHE
Lidocaine |
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