Term
| Phases of Migraine Headaches |
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Definition
| premonitory features, aura, headache, and resolution |
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Term
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Definition
| pt my experience mood & appetite changes hours to days before migraine attack; neurologic symptoms (photophobia, phonophobia), psychological symptoms (anxiety, depression, euphoria, irritability, drowsiness, hyperactivity, restlessnes); autonomic symptoms (polyuria, diarrhea, constipation); & constitutional symptoms (stiff neck, yawning, thirst, food cravings, anorexia) |
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Definition
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Definition
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Term
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Definition
| phase of a migraine attack that refers to focal neurological symptoms that occur in 31% of pts with migraines; usually lasts less than 1 hr & usually ends 1 hr before headache phase starts |
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Term
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Definition
| phase of migraine that starts about 1 hr after the end of aura; progresses from a dull ache to intense unilateral pulsations taht worsen over time; about 90% of pts will have GI symtpoms like nausea and vomiting; may also experience photophobia, phonophobia, or osmophobia during this phase; pain begins in frontotemporal region & may extend to neck & back of skull; may last 4 to 72 hrs if left untreated |
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Term
| Alleviating headache phase of Migraine Attacks |
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Definition
| rest in a dark room; DO NOT do any physical activity |
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Term
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Definition
| during this phase, pts may feel tired/depressed or refreshed/euphoric |
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Term
| Cause of Migraine Headaches |
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Definition
| thought to result from inappropriate dilation of intracranial extracerebral blood vessels; inappropriate activation of trigeminal complex which causes dilation of intracranial blood vessels through the inappropriate release of CGRP (calcitonin gene-related product), NKA (neurokinin A), & SP (substance P) |
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Term
| Prophylactic Therapy of Migraines |
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Definition
| type of treatment used when frequent attacks requiring acute medication more than twice a week |
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Term
| Treatment of Mild-Moderate Acute Therapy Symptoms |
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Definition
| 1st line: analgesics, NSAIDS (acetaminophen, APAP/aspirin/caffeine, aspirin, ibuprofen, naproxen); 2nd line: combination analgesics (midrin, aspirin/butalbital/caffeine); 3rd line: triptans; 4th line: opioid combination analgesics, butorphanol nasal spray |
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Term
| Treatment of Severe Symptomatic Acute Attacks |
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Definition
| 1st line: DHE or ergotamine tartrate (bypass NSAIDs, analgesics, combos); 2nd line: triptans; 3rd line: opioid combination analgesics |
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Term
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Definition
| medication overuse headache that occurs when using drugs for abortive treatment of migraines; characterized by increased frequency of headaches and an increase in drug consumption; most commonly occurs when taking: combo analgesics, opiates, ergotamine tartrate, & triptans; use these meds only about 2 times per week to avoid problem |
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Term
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Definition
| used as abortive treatment of migraines; analgesics; MoA: ability to block prostaglandin synthesis which prevents inflammation in trigeminovascular system & lessens pain sensitization; Use with caution in pts with peptic ulcer disease, renal disease, or hypersensitivies to aspirin |
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Term
| isometheptene + dichoralphenazone + APAP (Midrin) |
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Definition
| combo analgesic that is as effective as oral ergotamine tartrate with fewer side effects; first drug in combo is a synthetic sympathomimetic with alpha & beta-adrenergic activity causing mild vasoconstrictor activity; 2nd drug in product is included for its sedative effect; C/I's: glaucoma, renal disease, HPN, heart & liver disease, concurrent use with MAOI's |
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Term
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Definition
| last resort medications for treatment to abort migraines; reserved for severe infrequent HAs where conventional therapies are not effective or are contraindicated |
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Term
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Definition
| oral, sublingual, and suppository drug used in acute treatment of moderate to severe migraines; MoA: "dirty drug" that interacts with serotonin, DA, and adrenergic receptors; effectiveness is mediated by activation of 5-HT1b receptors & vasoconstriction of dilated intracranial arteries, resulting in decreased pulsations, also may reduce neurogenic inflammation; Max oral/sublingual dose: 6 mg/attack or 10 mg/wk; may be combined with caffeine to potentiate vasoconstriction & improve intestinal absorption; may be combined with Belladonna alkaloids to reduce nausea & vomiting |
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Term
| Toxicity, ADRs, C/I's for ergotamine tartrate |
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Definition
| drug is a powerful vasoconstrictor; C/I: pts with peripheral vascular disease, beta-blockers may potentiate vasoconstriction caused by drug; GI upset (nausea, vomiting, anorexia): activates central DA receptors in CRTZ, may require adjunctive therapy with metoclopramide (Reglan); erythromycin can interfere with liver metabolism of ergotamine & cause ergot toxicity; more C/I's: cardiovascular disease, sepsis, liver & kidney disease, pregnancy/breast feeding |
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Term
| Dihydroergotamine (D.H.E. 45) |
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Definition
| drug effective in acute treatment of moderate to severe migraines; incompletely absorbed in GI tract, administered parenterally; MoA: direct vasoconstriction of dilated intracranial arteries leading to decreased pulsations & reduced neurogenic inflammation by decreasing release of vasodilator/proinflammatory neuropeptide transmitters; causes less vasoconstriction than ergotamine |
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Term
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Definition
| derivative of serotonin used in acute treatment of moderate to severe migraines; SC, PO, or nasal spray forms; metabolized by MAO-A; MoA: constriction of inflamed/dilated intracranial arteries & by inhibiting release of vasodilator/proinflammatory mediators, relieves nausea, vomiting, photophobia, & phonophobia associated with migraine attacks; SEs: cardiovascular (MIs...C/I in pts with pre-existing coronary artery disease), injection site rxn, triptan symptoms (chest & throat tightness, difficulty in breathing, panic/anxiety, paresthesias, feeling of heaviness), C/I with use of a MAOI |
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Term
| second generation triptans (zolmitriptan [Zomig], etc.) |
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Definition
| triptans with greater bioavailability; act at peripheral components of trigeminovascular system; have greater lipid solubility, and act centrally to inhibit pain transmission in trigeminal nucleus |
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Term
| prochlorperazine (Compazine) |
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Definition
| DA antagonist useful for treatment of acute migraine unresponsive to sumatriptan, DHE, or oral analgesics; relieve headache pain & have anti-emetic activity |
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Term
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Definition
| effective agent for prophylactic management of migraine & cluster headaches; prescribed only when other prophylactic therapies (propanolol) fail; no longer available in US; MoA: 5-HT2 receptor antagonist and 5-HT1 receptor agonist; NOT effective for acute treatment of migraines; protective effect takes 1-2 days to develop; SE's: FIBROSIS & FIBROTIC COMPLICATIONS - to avoid, d/c drug for about 4 weeks every 6 months, CV: angina, CNS: LSD-like effects; C/I's: pts with cardiovascular disease & fibrotic disease |
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Term
| propanolol (Inderal) & timolol |
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Definition
| first drugs of choice for migraine prophylaxis; beta-blockers that lack partial agonist activity (ISA) are most effective; SEs: fatigue, cold extremities, dizziness, CNS side effects, impotence |
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Term
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Definition
| tricyclic antidepressant that can be used to prophylactically treat migraines; MoA: unknown but thought to involve down regulation of central 5-HT2 and adrenergic receptors; SEs: anticholinergic effects (dry mouth, blurred vision, urinary retention, cardiac arrhythmias); C/I in pts with glaucoma, BPH, & heart disease |
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Term
| calcium channel blockers (verapamil) |
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Definition
| unapproved use to treat migraines prophylactically; questionable effectiveness, takes up to 8 wks for any possible advantages; MoA: unknown but thought to alter vascular smooth muscle reactivity; SEs: constipatoin, orthostatic hypotension; C/I's: bradycardias, concomitant use of beta-blockers |
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Term
| valproic acid:valproate sodium 1:1 (Depakote) |
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Definition
| antiepileptic drug found to be effective in migraine prophylaxis; MoA: facilitating GABA neurotransmission, modulating glutamate, & inhibiting Na & Ca channel activity; SE's: N/V, weakness, somnolence, weight gain, tremor, hair loss, hepatic toxicity |
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Term
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Definition
| anticonvulsants used to prophylactically treate migraines; Adverse Effects: paresthesia, fatigue, anorexia, weight loss, diarrhea, memory problems, & nausea |
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Term
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Definition
| anticonvulsants used to treat migraines prophylacticaly; Adverse Effects: somnolence, asthenia (weakness), dizziness |
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