>=15 MMD for at least 3 months; at least 8 MHD
What makes someone qualify for Chronic Migraines? (2)
>=5 attacks lasting 4-72 hrs, N/V or photophobia/phonophobia, at least 2 HA qualities
What are the diagnostic criteria for Migraines? (3)
unilateral location, pulsating quality, moderate/severe pain, aggravated by routine physical activity
Which HA qualities align with a migraine? (4)
onzetra xsail, tosymra, zolmitriptan
What are the nasal triptans? (3)
ergot alkaloids; stimulates chemoreceptor trigger zone
Which Abortive therapy can cause nausea & vomiting? Why?
e
Which is first-line for treating migraines?
a) Triptans
b) Ergot Alkaloids
c) Lasmiditan
d) CGRP antagonist
e) Analgesics/NSAIDs
c
Which has a max 1 dose/24 hours?
a) Triptans
b) Ergot Alkaloids
c) Lasmiditan
d) CGRP antagonist
e) Analgesics/NSAIDs
b,c
Which are used ONLY to treat acute migraine attacks?
a) Rimegpant
b) Urbogepant
c) Zavegepant
a
Which are approved to prevent AND treat acute migraine attacks?
a) Rimegpant
b) Urbogepant
c) Zavegepant
metclopramide +/- aspirin, prochlorperazine, promethazine
What are the anti-emetic options? (3)
NSAIDs, opiates, butalbital, triptans, ergot alkaloids
Which medications cause Medication-Overuse Headache (MOH)? (5)
limit acute migraine therapy to 2-3days/week or 10 days a month
How can we prevent MOH?
acute tx >=2 days/week or >= 3x/month, significantly debilitating attacks despite appropriate management, MOH, difficult tolerating/CI to acute therapy
What are the indications for prophylaxis therapy? (4)
first line agent; titrate dose every 2-4 weeks, try different 1st line, combine two 1st line agents, 2nd line
How do we initiate prevention therapy? (4)
NSAIDs, triptans, beta blocker, verapamil, TCA, venlafaxine, anticonvulsant
What are the 1st line prophylactic treatments? (7)
CGRP antagonist, beta blocker + verapamil, consult HA specialist
What are the 2nd line, prophylactic treatments? (3)
a
Which is most widely used for migraine prophylaxis?
a) beta antagonist
b) amitriptyline
c) anti-seizure
d) CGRP antagonist
e) venlafaxine
metoprolol, propranolol, tindolol
Which beta-blockers have established efficacy? (3)
b
Which can cause anticholinergic effects?
a) beta antagonist
b) amitriptyline
c) anti-seizure
d) CGRP antagonist
e) venlafaxine
e
Which can cause nausea/vomiting/drowsiness?
a) beta antagonist
b) amitriptyline
c) anti-seizure
d) CGRP antagonist
e) venlafaxine
benign prostatic hyperplasia, glaucoma
Which patients do we avoid with Amitriptyline? (2)
c
Which one is useful when patients have anxiety or bipolar?
a) beta antagonist
b) amitriptyline
c) anti-seizure
d) CGRP antagonist
e) venlafaxine
Erenumab (Aimovig)
Which CGRP antagonist can worsen pre-existing hypertension?
d
Which must be avoided with strong CYP3A4 inhibitors/inducers?
a) beta antagonist
b) amitriptyline
c) anti-seizure
d) CGRP antagonist
e) venlafaxine
NSAIDs, triptans
Which medications can be used for Menstrual Migraine prophylaxis? (2)
systemic symptoms (fever), neuroplasm/neurologic deficit, sudden onset, pattern change, pregnancy, painful eye, immunodeficient, older age, papilledema
What are the red-flags for OTC migraine treatment? (9)