Migraine & Drugs

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Author:
missrx2013
ID:
174569
Filename:
Migraine & Drugs
Updated:
2012-09-30 22:14:16
Tags:
Migraine
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Description:
Migraine
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  1. Migraine Definition
    Decreased in serotonin -> release of neuropeptides -> vasodilation
  2. Common Migraine Triggers
    • Hormonal changes
    • Foods (beer, red wine, aged cheese, chocolate)
    • Stress
    • Sensory Stimuli (bright lights, sun, loud sounds)
    • Missing Sleep
    • Changing weather
  3. Natural Products for Tx
    • Butterbur
    • Coenzyme Q10
    • Feverfew
    • Fish Oils
    • Guarana
    • Magnesium
    • Riboflavin
    • Willow bark (salicylate)
  4. Triptans
    • Acute Tx for migraines
    • 5HTReceptor Agonists
    • constriction of  vessels, ihibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
    • Naratriptan (Amerge)
    • Frovatriptan (Frova)
    • Almotriptan (Avert)
    • Sumatriptan (Imitrex)
    • Rizatriptan (Maxalt, Maxalt XLT)
    • Eletriptan (Relpax)
    • Zomitriptan (Zomig, Zomig ZMT)
  5. Naratriptan
    • AMERGE-5HT1 Receptor Agonists
    • :LONG ACTING
    • :Acute Tx for migraines
    • :constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  6. Frovatriptan
    • FROVA-5HT1 Receptor Agonists
    • LONG ACTING
    • Acute Tx for migraines
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  7. Almotriptan
    • AXERT- 5HT1 Receptor Agonist
    • SHORT ACTING
    • Acute Tx for migraines
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  8. Sumatriptan
    • IMITREX- 5HT1 Receptor Agonist
    • SHORT ACTING
    • PO - 25, 50, 100mg (Can repeat 1x after 2hr)
    • Injection - 4, 6mg (can repeat 1x after 1hr)
    • Nasal Spray - 5, 20mg (can repeat 1x after 2hr)
    • Acute Tx for migraines
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  9. Rizatriptan
    • MAXALT, MAXALT XLT - 5HT1 Receptor Agonist
    • SHORT ACTING
    • Acute Tx for migraines
    • PO - 5, 10 mg (can repeat 1x after 2 hr)
    • Disinteg. tab. - 5mg (no water needed)
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  10. Eletriptan
    • RELPAX - 5HT1 Receptor Agonist
    • SHORT ACTING
    • Acute Tx for migraines
    • PO - 20, 40mg (can repeat 1x after 2hr)
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria
  11. Zolmitriptan
    • ZOMIG, ZOMIG ZMT - 5HT1 Receptor Agonist
    • SHORT ACTING
    • Acute Tx for migraines
    • PO - 2.5, 5mg (can repeat after 2hr)
    • Nasal Spray - 5mg (can repeat after 2hr)
    • Disinteg. tab. - 2.5, 5mg (no water needed)
    • constriction of  vessels, inhibits neuropeptide release, dec pain transmission
    • S/E: triptan sensations, hot/cold sensations, paresthesia, nausea, dizziness
    • CI: cerebrovascular d(x), uncontrolled HTN, MAOI, serotonergics, phenylketonuria

    • Nasal Spray Counseling:
    • blow nose gently before use
    • do not prime nasal spray
    • do not press plunger until tip is in nostril
  12. Fioricet / Fioricet w/Codeine
    • APAP/Butalbital/Caffeine 
    • Acute Migraine Tx
    • Must taper off or worsening of HA
    • Do NOT mix with alcohol
    • Do NOT exceed 4g of APAP in 1 day
    • S/E: N/V, abdominal pain, sedation
  13. Fiorinal / Fiorinal w/Codeine
    • ASA/Butalbital/Caffeine
    • Acute Migraine Tx
    • Must taper off or worsening of HA
    • Do NOT mix with alcohol
    • S/E: Somnolence
  14. Ergotamines
    • ERGOMAR
    • ERGOSTAT
    • CAFERGOT (ergotamine w/caffeine)
    • DIHYDROERGOTAMINE (DHE-45, Migranal nasal spray)
    • Pregnancy X
    • BBW: Do NOT use with CYP3A4 Inhibitors ->risk of cerebral ischemia
    • S/E: N/V, muscle pain, angina, tachy/bradycardia, leg weakness  
  15. Migraine Prophylaxis
    • ~50 % reduction in migraines
    • Use if >1 migraine/mo
    • Use if severe migraines
    • May have to try 1+ agent b4 finding one that works for that pt.
    • Try for 2-6mo before switching
    • 1st line: Propranolol, Timolol, Topiramate, Na Valproate, Amitriptyline, Divalproex
    • 2nd line: ACE, Antidepressants, BCPs, Botulinum toxin A inj.
  16. Rebound HA
    • Medication overuse
    • NSAIDs
    • Narcotics
    • Analgesic combination products
    • Triptans
    • Ergotamines (except DHE)
    • Limit acute treatment meds to 2-3x/wk

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