Comprehensive Flashcards on Migraine Treatments and Medications

Migraine with aura puts women at higher risk for _____ and they should not use _____

stroke

should not use estrogen-containing contraceptives

common food triggers

veer, red wine, aged cheese, chocolate, aspartame, caffeine, msg, salty foods, processed foods

diagnosis of migraines includes:

-at least 5 attacks

-headaches lasting 4-72 hours

-unilateral location/uplsating

-nausea/vomiting, photophobia, phonophobia

natural products in treating migraine

butterbur, feverfew, magnesium, riboflavin

advil migraine contains

ibuprofen only

excedrin migraine contains

aspirin, acetaminophen, caffeine

t/f: opioids, butalbital-containing products, and tramadal and tapentadol are recommended as well in migraine

false: these products are not recommended due to abuse/dependence issues. they may be used in select cases

Triptans MOA

agonists at 5-HT1 receptor, cause vasoconstriction of cranial blood vessels

First-line in acute treatment of migraines

triptans

triptans should be administered:

at first sign of a migraine

contraindications to triptans

cerebrovascular disease (stroke/TIA)

uncontrolled HTN, ischemia heard disease

use within 24H of another triptan

warnings of triptans and side effects

increase in bp, serotonin syndrome

side effects: paresthesias (tingling/numbness)

triptan sensation: pressure/heaviness in chest or pressure in neck region

notes for triptans

nasal sprays/injections work faster than ODTs

non-tablet formulations are ideal if nausea is present

nasal sprays contain 1 dose (don't prime)

Treximet (imitrex+naproxen) dispense in original naproxen)

Treximet must be

dispensed in original container

Maxalt notes

do not give to patients w/ phenylketonuria (due to containing phenylalanine

Only triptan approved in children aged 6-11

rizatriptan (all others 12+

longest half life triptan

frovatriptan

considerations about long half-life triptans

onset is slower (shorter half-life triptans have faster onset)

preferred site of SC triptan injection

lateral thigh, upper arm

Zomig generic

zolmitriptan

onzetra Xsail in nasal powder formulation of

sumatrimtan

onzetra xsail is administered

in one nostril

subQ sumatriptan can be repeated one time after

1 hour

nasal formulations of sumatriptan can be repeated one time after

2 hours

Zolmitriptan dosing can be repeated one time after

2 hours

zolmitriptan is available as

ODT, tablet, nasal spray

only triptan available as subQ injection/autoinjector

sumatriptan

triptans available as tablet

all triptans

triptans available as ODT

rizatriptan, zolmitriptan

nasal formulations of triptan

spray: sumatriptan, zolmitrptal

powder: sumatriptan

triptans are contraindicated with the use of

mao inhibitors (or wihtin 2 weeks of stopping)

don't use triptans with

strong CYP3A4 inhibitors and mao inhibitors

ergotamine moa

nonselective agonist of serotonin receptors (that causes cerebral vasoconstriction) used in patients who dn't find benefit with a triptan

migranal generic

dihydroergotamine

D.H.E 45 generic

dihydroergotamine

Migranal is contraindicated with

potent cyp3A4 inhibitors (life threatening peripheral iscehmia), uncontrolled HTN, pregnancy, ischemic heart disease

boxed warning of ergotamines

concurrent use with potent CYP3A4 inhibitors: life-threatnening peripheral ischemia

notes of ergotamine and triptan nasal formulations

nasal formulations of triptans do NOT prime, nasal spray of ergotamines MUST be primed

warnings with ergotamines

cardiovascular and cerebrovascular events, drug interactions

rimegepant and ubrogepant belong to the class:

CGRP receptor antagnoists

Ubrelvy is used to treat

acute migraine attacks

Rimegepant is used to

prevent and treat acute migraine attacks

lasmitidan brand name

Reyvow

Reyvow moa/class

serotonin agonist selective for 5HT1F receptor subtype, does not cause vasoconstriction

notes about lasmiditan

not contraindicated in patients with CVD

migraine medication that is a schedule 5 drug

lasmiditan (reyvow)

Reyvow is a schedule:

V

Ubrelvy generic

ubrogepant

butalbital drug class

barbiturate

fioricet generic

acetaminophen & butalbital & caffeine

fiorinal generic

butalbital/aspirin/caffeine

Schedule of fioricet, fioricet with codeine, and fiorinal with codeine

fioricet: exempt

fioricet w/ codeine and fiorinal w/ codeine: schedule III

Risks of butalbital-containing products

long-term use will cause worsening of headache, tremors, risk for delirium, seizures, abuse/dependence

will need to be tapered off

Candidates for prophylactic drug treatment are patients that

use acute treatment 2+ days/week or 3+ times a month

migraines decrease their quality of life or acute treatments are contraindicated/ineffective

best evidence with this beta blocker compared to others

propranolol

antiepileptic drugs used in prophylaxis of migraines

topiramate, valproic acid

antidepressants commonly used in prophylaxis

amitriptyline (lower dose than depression)

venlafaxine

side effects of beta blockers

caution with bronchospastic diseases asthma/COPD especially w/ non-selective BBs (propranolol)

bradycardia, fatigue, hypotension, dizziness, depression (moreso w/ propranolol, most lipophilic (causes CNS), impotence) exacerbate reynaud's

propranolol is a ____ beta blocker

non-selective

metoprolol is a ____ beta blocker

beta-1 selective

depakote sprinkle boxed warnings

fetal harm, hepatic failure

warnings/side effects of depakote ER

weight gain, thrombocytopenia, increased ammonia, alopecia

topamax warnings and side effects

feta harm, metabolic acidosis, neprholithiasis, increased ammonia, open angle glaucoma, visual field defects, oligohidrosis, weight loss, somnolence, cognitive impairment

Rimegepant ODT is taken

PO every other day

quilipta is taken

daily

atogepant brand name

quilipta

vyepti is taken

every three months (IV)

(eptinezumab)

Ajovy is taken

monthly, SC, or higher dose every 3 months, SC

(fremanzeumab)

Emgality is taken

SC, monthly

(elgamcanezumab)

Galcanezumab brand

emgality

Erenumab is taken

monthly, SC

(aimovig)

Aimovig generic

erenumab

Injectable CGRP antagonists are monoclonal antibodies approved for

migraine prevention

Botulinum toxin type A (Botox) injections are used for

prophylaxis

candidates for botox have

chronic migraines only (15+ headache days/month)

to reduce overuse of headache medication, limit acute treatment to

2-3 times/week

all triptans can cause

serotonin syndrome if taken with agents that increase serotonin

Zomig contains ___ don't use if you have

phenylalanine

avoid if you have phenylketonuria

Onzetra Xsail nasal powder requires you to blow into the devise with your mouth for _____ to deliver the notification _____

blow 2-3 seconds

to deliver med to your nose

(must deliver to each nostril)