Emergency Medical Minute

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 an