2023-12-07T20:33:39+03:00[Europe/Moscow] en true <p>&gt;=15 MMD for at least 3 months; at least 8 MHD</p>, <p>&gt;=5 attacks lasting 4-72 hrs, N/V or photophobia/phonophobia, at least 2 HA qualities </p>, <p>unilateral location, pulsating quality, moderate/severe pain, aggravated by routine physical activity </p>, <p>onzetra xsail, tosymra, zolmitriptan </p>, <p>ergot alkaloids; stimulates chemoreceptor trigger zone </p>, <p>e</p>, <p>c</p>, <p>b,c </p>, <p>a</p>, <p>metclopramide +/- aspirin, prochlorperazine, promethazine </p>, <p>NSAIDs, opiates, butalbital, triptans, ergot alkaloids</p>, <p>limit acute migraine therapy to 2-3days/week or 10 days a month </p>, <p>acute tx &gt;=2 days/week or &gt;= 3x/month, significantly debilitating attacks despite appropriate management, MOH, difficult tolerating/CI to acute therapy </p>, <p>first line agent; titrate dose every 2-4 weeks, try different 1st line, combine two 1st line agents, 2nd line</p>, <p>NSAIDs, triptans, beta blocker, verapamil, TCA, venlafaxine, anticonvulsant </p>, <p>CGRP antagonist, beta blocker + verapamil, consult HA specialist </p>, <p>a</p>, <p>metoprolol, propranolol, tindolol </p>, <p>b</p>, <p>e</p>, <p>benign prostatic hyperplasia, glaucoma </p>, <p>c</p>, <p>Erenumab (Aimovig) </p>, <p>d</p>, <p>NSAIDs, triptans </p>, <p>systemic symptoms (fever), neuroplasm/neurologic deficit, sudden onset, pattern change, pregnancy, painful eye, immunodeficient, older age, papilledema </p> flashcards
Migraine Therapeutics

Migraine Therapeutics

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  • >=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)