Question

A 35-year old lady suffers from recurrent attacks of migraine. She experiences severe headaches with associated visual auras 5 days a month. Over-the-counter analgesics were ineffective. Her migraines are more frequent when she has her menses. 

(a) Describe the mechanism of action of non-steroidal anti-inflammatory drugs in acute migraine. (3 marks) 

(b) Explain the mechanism of action of triptans in the treatment of acute migraine. What are the contraindications? (4 marks) 

(c) What is the mechanism of action of gepants in acute migraine? What are the common side effects of gepants? (3 marks) 

(d) Describe FOUR classes of drugs that may be used first line for migraine prophylaxis. What are the common side effects for each of these medications? (4 marks) 

(e) What is "medication overuse headache"? How is this defined? (3 marks) 

(f) How should medication overuse headache be managed? (3 marks) 


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