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Podcast 883: Migraine Treatment in Cardiovascular Disease
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Manage episode 391525476 series 1397179
Contributor: Jorge Chalit, OMS II
Educational Pearls:
Migraine pathophysiology
Primarily mediated through the trigeminovascular system
Serotonin, dopamine, and calcitonin gene-related peptide (CGRP)
Trigeminovascular system is linked to the trigeminal nucleus caudalis, which relays pain to the hypothalamus and cerebral cortex
One effective treatment for acute migraines is -triptan medications
5-HT1D/1B agonists such as sumatriptan
Often combined with NSAIDs and dopamine antagonists (as antiemetics) in migraine cocktails
Diphenhydramine (Benadryl) was shown to be ineffective in a randomized controlled trial comparing it with placebo and a dopamine antagonist antiemetic.
The -triptan medications carry significant risk for peripheral vasoconstriction and are therefore avoided in cardiovascular disease
One serotonin agonist specifically approved for use in vascular disease
Lasmiditan - 5-HT1F agonist
Slightly different mechanism of action avoids peripheral vasoconstriction
CGRP antagonists are also used in patients who are unresponsive to -triptans
References
1. Friedman WB, Cabral L, Adewunmi V, et al. Diphenhydramine as adjuvant therapy for acute migraine. An ED-based randomized clinical trial. Ann Emerg Med. 2016;67(1):32-39.e3. doi:doi:10.1016/j.annemergmed.2015.07.495
2. Lasmiditan (Reyvow) and ubrogepant (Ubrelvy) for acute treatment of migraine. (2020). The Medical letter on drugs and therapeutics, 62(1593), 35–39.
3. Robbins MS. Diagnosis and Management of Headache: A Review. JAMA - J Am Med Assoc. 2021;325(18):1874-1885. doi:10.1001/jama.2021.1640
4. Vanderpluym JH, Halker Singh RB, Urtecho M, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA - J Am Med Assoc. 2021;325(23):2357-2369. doi:10.1001/jama.2021.7939
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
1052 פרקים
Fetch error
Hmmm there seems to be a problem fetching this series right now. Last successful fetch was on May 06, 2024 11:18 ()
What now? This series will be checked again in the next day. If you believe it should be working, please verify the publisher's feed link below is valid and includes actual episode links. You can contact support to request the feed be immediately fetched.
Manage episode 391525476 series 1397179
Contributor: Jorge Chalit, OMS II
Educational Pearls:
Migraine pathophysiology
Primarily mediated through the trigeminovascular system
Serotonin, dopamine, and calcitonin gene-related peptide (CGRP)
Trigeminovascular system is linked to the trigeminal nucleus caudalis, which relays pain to the hypothalamus and cerebral cortex
One effective treatment for acute migraines is -triptan medications
5-HT1D/1B agonists such as sumatriptan
Often combined with NSAIDs and dopamine antagonists (as antiemetics) in migraine cocktails
Diphenhydramine (Benadryl) was shown to be ineffective in a randomized controlled trial comparing it with placebo and a dopamine antagonist antiemetic.
The -triptan medications carry significant risk for peripheral vasoconstriction and are therefore avoided in cardiovascular disease
One serotonin agonist specifically approved for use in vascular disease
Lasmiditan - 5-HT1F agonist
Slightly different mechanism of action avoids peripheral vasoconstriction
CGRP antagonists are also used in patients who are unresponsive to -triptans
References
1. Friedman WB, Cabral L, Adewunmi V, et al. Diphenhydramine as adjuvant therapy for acute migraine. An ED-based randomized clinical trial. Ann Emerg Med. 2016;67(1):32-39.e3. doi:doi:10.1016/j.annemergmed.2015.07.495
2. Lasmiditan (Reyvow) and ubrogepant (Ubrelvy) for acute treatment of migraine. (2020). The Medical letter on drugs and therapeutics, 62(1593), 35–39.
3. Robbins MS. Diagnosis and Management of Headache: A Review. JAMA - J Am Med Assoc. 2021;325(18):1874-1885. doi:10.1001/jama.2021.1640
4. Vanderpluym JH, Halker Singh RB, Urtecho M, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA - J Am Med Assoc. 2021;325(23):2357-2369. doi:10.1001/jama.2021.7939
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
1052 פרקים
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