Headaches and Migraine Triggers

Study Notes

Pathophysiology of Migraines

Caused by abnormal brain activity that impacts nerve signals, chemicals, and blood vessels.
Common triggers include hormonal changes, stress, specific foods, and environmental factors.

Foods that Trigger Migraines

Aged cheeses
Processed meats
Chocolate
Alcohol (particularly red wine)
Caffeine
Artificial sweeteners

Abortive Treatment Drug Classes

Triptans (e.g., Sumatriptan)
- Selective serotonin receptor agonists that mitigate inflammation and constrict blood vessels.
- Sumatriptan:
  - Side effects: bad taste, chest symptoms, coronary vasospasm, teratogenesis.
  - Contraindicated in pregnancy, heart disease, and certain conditions (geriatric, severe liver disease, MAOIs within 2 weeks).
  - Laboratory tests: liver function tests (LFTs), creatinine clearance.
  - Maximum dosage: 20mg per day.
- Zolmitriptan: Available in oral and intranasal forms, may have an unpleasant taste.
- Frovatriptan: Notable for its long half-life of 26 hours.
Ergot Alkaloids (e.g., Ergotamine)
- Function through blood vessel constriction.
- Ergotamine:
  - Side effects: muscle pain, paresthesia, cold extremities, potential for physical dependence.
  - Risk of severe vasoconstriction leading to peripheral vascular ischemia or gangrene.
  - Contraindicated in hepatic/renal impairment and cardiovascular conditions (CAD, PVD) and in pregnancy.
  - Black box warning against use with potent CYP inhibitors (protease inhibitors, azole antifungals, certain macrolides).
NSAIDs (e.g., Ibuprofen, Naproxen)
- Serve to reduce inflammation and relieve pain.
Treximet
- Combination product of Sumatriptan and Naproxen.
Ubrogepant
- Newer treatment, safe for use during breastfeeding; potential drug interactions include azoles, macrolides, fluoroquinolones, and grapefruit juice.
Rimegepant
- Functions as both abortive and preventive; prescribed as 75mg as needed or every other day for prevention.

Preventive Medication Drug Classes

Beta-blockers (e.g., Propranolol)
- Effective in reducing the frequency and severity of migraines.
Antiseizure Medications (e.g., Topiramate, Divalproex, Tiagabine)
- Stabilize nerve cell membranes.
CGRP Monoclonal Antibodies (e.g., Erenumab)
- Block calcitonin gene-related peptide to decrease migraine occurrences; administered subcutaneously once monthly.
- Atogepant: Oral form requiring renal dosing.
Antidepressants (e.g., Amitriptyline)
- Used for preventive treatment.
Botulinum Toxin
- Requires multiple injections; variable effectiveness and high cost.

Herbal Medications for Migraines

Butterbur: Potential risk for liver toxicity.
Feverfew: May cause gastrointestinal discomfort and mouth ulcers.
Magnesium: Possible side effect is diarrhea.
Riboflavin (Vitamin B2): Well-tolerated with minimal side effects.

Treatment for Menstrual Migraines

NSAIDs and Triptans.
Hormonal therapy, such as low-dose estrogen patches, recommended 3 days prior to menstruation.

Description

Explore the pathophysiology of migraines and the various foods that can act as triggers. This quiz covers the physiological aspects and dietary influences on migraine occurrences. Understanding these factors can help in managing and preventing migraines effectively.