PHRM 211 Lecture Notes - Lecture 20: Medication Overuse Headache, Chemoreceptor Trigger Zone, Peripheral Artery Disease
Document Summary
Ergots (2nd/3rd line therapy that has fallen out of favor) Agonist at 5-ht1d receptors on intracranial blood vessels = vasoconstriction. Agonist at 5-ht1d receptors on sensory nerve endings in the trigeminal system = inhibition of proinflammatory neuropeptide release. Binds with high affinity to 5-ht 1d , 5-ht 1d , 5-ht 1a , 5-ht 2a , and 5-ht 2c receptors, noradrenaline 2a , 2b and 1 receptors, dopamine d 2l and d 3 receptors. Longer onset of action vs. triptans but also longer duration of action. Can be used as an outpatient but most often used for inpatient treatment of continuous migraine (> 72h) Ergotamine/caffeine (cafergot tablets) recently discontinued by manufacturer. Cardiac or cerebrovascular or peripheral vascular disease (or risk factors) Baseline cardiac evaluation/ecg for males > 40 yrs, females > 50 yrs. Chest discomfort, tingling/paresthesia, nausea (stimulates chemoreceptor trigger zone - give with metoclopramide ), drowsiness, dizziness, diarrhea, cramps. (nasal spray = rhinitis, taste disturbance)
