Migraine

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Author:
xinchen3
ID:
196213
Filename:
Migraine
Updated:
2013-01-28 21:52:29
Tags:
Migraine
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Description:
Migraine
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  1. Triptans (-triptan) - MoA
    • serotonine 5-HT1B & 5-HT1D receptor agonist
    • inhibits CGRP & substance P release
  2. Triptans (-triptan) - Use
    • acute migraine
    • photophobia, phono-phobia, pain & nausea relief
  3. Triptans (-triptan) - Adverse Effects
    • nausea, dizziness, muscle weakness
    • Coronary vasospasm
    • stroke & MI
    • serotonin syndrome
  4. Triptans (-triptan) - Contraindications
    • SSRI/SNRI
    • MAO inhibitors
  5. What is Serotonin syndrome?
    • Cognitive: Headache, confusion, hallucination, coma
    • Autonomic: sympathetic & parasympathetic over firing
    • Somatic: myoclonus, tremors
  6. Ergots - MoA
    • 5-HT agonist
    • alpha-adrenergic agonist (vasoconstriction)
  7. How are Ergots different from Triptans?
    • longer lasting
    • more side effects
    • Nasal spray
  8. Ergots - Adverse Effects
    • increase BP
    • vertico
    • diarrhea
    • thirst
    • easily overdose
  9. Dihydroergotamine (DHE)
    Ergots
  10. Ergotamine Tartrate
    Ergots
  11. Cafergot
    Ergots
  12. Isometheptene
    Ergots
  13. Other Anti-migraine therapies
    • Anti-nausea
    • Opiates - last resort drug
    • Glucocorticoid (Dexamethasone)
  14. Migraine Prophylaxis
    • Amitriptyline (SSRI)
    • Propranolol (Beta-blocker)
    • Ca2+ channel blockers
    • Anti-epileptics
  15. Treatment of mild migraine
    • Aspirines, acetaminophen, anti-emetics
    • inadequate => treat as severe migraine
  16. Treatment of Severe migraine
    Triptans/DHE => +Opioids => +corticosteroids
  17. what is the next step if severe migraine treatment does not work?
    prophylactic treatments

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