Module 3 Study Guide Part 2.docx

**[Headaches]** **Pathophysiology of migraine:** Migraines are believed to be caused by abnormal brain activity affecting nerve signals, chemicals, and blood vessels in the brain. Triggers can include hormonal changes, certain foods, stress, and environmental factors. **Foods that can trigger migr...

**[Headaches]** **Pathophysiology of migraine:** Migraines are believed to be caused by abnormal brain activity affecting nerve signals, chemicals, and blood vessels in the brain. Triggers can include hormonal changes, certain foods, stress, and environmental factors. **Foods that can trigger migraines:** - Aged cheeses - Processed meats - Chocolate - Alcohol (especially red wine) - Caffeine - Artificial sweeteners **Abortive treatment drug classes:** - Triptans(e.g., sumatriptan) : Selective serotonin receptor agonists that reduce inflammation and constrict blood vessels. - **Sumatriptan** - A/E: bad taste, chest symptoms, coronary vasospasm, teratogenesis - Contra: pregnancy, heart disease, not rec for geriatric/severe liver disease/MAOIs use in past 2 weeks - Labs: LFTs, creatinine clearance - Zomitriptan: oral and intranasal, tastes bad - Frovatriptan: longest half life! 26hrs - Ergot alkaloids (e.g., ergotamine): Constrict blood vessels in the brain. - **Ergotamine** - A/E: muscle pain, paresthesia, cold extrem, physical dependence - Intense vasoconstriction peripheral vascular ischemia and possible gangrene - Contra: hepatic/renal impairment, CAD, PVD, pregnancy - BBW: contraindicated with potent inhibitors of CYP (protease inhibitors, azole antifungals, and some macrolides) - NSAIDs (e.g., ibuprofen, naproxen): Reduce inflammation and pain. - Treximet (e.g., Treximet): Combination of sumatriptan and naproxen. - Urbogepant (new!) - Can be used during breastfeeding - Drug interactions: azoles, macrolides, floxins, grapefruit juice - Rimegepant - Can be abortive and preventive - 75mg as needed - 75mg every other day (preventive) - Lasmitidan - First in class Serotonin 1F receptor agonist drowsiness in geriatric ALL ABORTIVES CAN CAUSE OVERUSE HEADACHES put on preventive **Drug classes for preventive medications:** - Beta-blockers (e.g., propranolol): Reduce frequency and severity of migraines. - Antiseizure medications(e.g., topiramate, divalproex, tiagabapine) : Stabilize nerve cell membranes. - CGRP monoclonal antibodies (e.g., erenumab): Block calcitonin gene-related peptide to reduce migraine frequency. - Subq injection dosed once monthly - Atogepant - Oral - Renal dosing - Antidepressants (e.g., amitriptyline) - Botulism - Requires a lot of injections. Variable effects. Expensive **Herbal medications effective with migraines and their side effects:** - Butterbur: Potential liver toxicity - Feverfew: Gastrointestinal symptoms, mouth ulcers - Magnesium: Diarrhea - Riboflavin (Vitamin B2): Generally well-tolerated **Treatment for menstrual migraine:** - NSAIDs - Triptans - Hormonal therapy (e.g., estrogen patches)