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  /Subject (Migraine Pharmacology Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Migraine Pharmacology Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Bailey\_Rickett} via \textcolor{DarkBackground}{\uline{cheatography.com/184326/cs/38433/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Bailey\_Rickett \\
  \uline{cheatography.com/bailey-rickett} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 28th April, 2023.\\
   Updated 28th April, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Serotonin Pathophysiology (5HT)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Serotonin is synthesized from L-tryptophan} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Free Serotonin is either stored in vesicles, or it is rapidly inactived by MAO.} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{In the pineal gland, serotonin is a precursor to Melatonin (sleep).} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{L-tryptophan-\textgreater{}Serotonin-\textgreater{}Melatonin} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Over 90\% of serotonin in mammals is found in enterochromaffin cells in the gut, where is regulates peristalsis.} \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Serotonin is also found in the blood in platelets (makes them sticky) and in the brain.} \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Brain serotonin neurons are involved in mood, sleep, appetite, temperature regulation, pain, blood pressure regulation, and vomiting. (It may also play a role in aggression.} \tn 
% Row Count 15 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Serotonin leads to platelet aggregation.} \tn 
% Row Count 16 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Serotonin directly causes contraction of VASCULAR smooth muscle and is a powerful VASOCONSTRICTOR, except in skeletal muscle and the heart where it is a vasodilator.} \tn 
% Row Count 20 (+ 4)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{5HT is involved in the mechanisms of depression, anxiety, and migraine.} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Triptans- Serotonin Agonist Drug Therapy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{These drugs are agonists of 5HT1B a 5HT1D of inhibit the release of CGRP, substance P, and neurokinin A.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 12 (+ 9)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Rizatriptan, Sumatriptan, and Zolmitriptan are {\bf{contraindicated}} with MAOIs.} \tn 
% Row Count 14 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indicated for acute migraine management.} \tn 
% Row Count 15 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Contraindicated}} with IHD, angina, history of a stroke, CVD, uncontrolled HTN, ischemic bowel disease, use with ergots, use with other triptans within 24 hours, QT prolongation, pregnancy (causes contraction of the uterine smooth muscle), hepatic failure, renal failure, and basilar migraines (brainstem origin)} \tn 
% Row Count 22 (+ 7)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Consider a triptan with a nasal spray or injectable formulation in patients with severe nausea/vomiting, migraines that quickly intensity, or patients who awake with migraines (these formulations allow for a faster onset of action)} \tn 
% Row Count 27 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Almo, Suma, Riza, and Zolmi have a shorter life so they may require multiple doses to prevent off periods.} \tn 
% Row Count 30 (+ 3)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Triptans- Serotonin Agonist Drug Therapy (cont)}}  \tn
% Row 7
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\mymulticolumn{1}{x{5.377cm}}{Frovatriptan is the longest acting but least effective triptan.} \tn 
% Row Count 2 (+ 2)
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\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Almotriptan (Axert)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: Acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: Dry mouth, paresthesia, dizziness, tachycardia, muscle weakness, triptan sensations (burning, flushing, tingling, and tightness of face)} \tn 
% Row Count 14 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with MAOIs} \tn 
% Row Count 15 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Better tolerated than sumatriptan, only FDA approved triptan for children, best tolerated overall.} \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Eletriptan (Relpax)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: oral} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: dry mouth, paresthesias, dizziness, tachycardia, muscle weakness, triptan sensations.} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI within 72 hours of CYP3A4 inhibitors (clarithromycin, azoles, ritonavir), CI in hepatic or renal impairment.} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: NOT CI with MAOIs.  Has the highest potential for drug interactions.} \tn 
% Row Count 18 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Zolmitriptan (Zomig)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: oral or oral dissolving tablet} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: dry mouth, parasthesias, dizziness, tachycardia, muscle weakness, triptan sensations} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with MAOIs in the past 2 weeks} \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: used when others failed} \tn 
% Row Count 16 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Sumatriptan (Imitrex)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral, Spray, SQ injection, combo products} \tn 
% Row Count 12 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: dry mouth, paresthesias, dizziness, tachycardia, muscle weakness, triptan sensations} \tn 
% Row Count 14 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with MAOIs within 2 weeks, CI in hepatic impairment} \tn 
% Row Count 16 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: fastest onset of orals, highest potency with SQ injection, only triptan that is safe in pregnancy/breastfeeding} \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rizatriptan (Maxalt)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral or Oral Dissolving Tablet} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: dry mouth, paresthesias, dizziness, tachycardia, muscle weakness, triptan sensations} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with MAOIs in the past two weeks} \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: better when given prior to an event (such as with mensuration)} \tn 
% Row Count 17 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Frovatriptan (Frova)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine management} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: oral} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side effects: dry mouth, paresthesias, dizziness, tachycardia, muscle weakness, triptan sensations} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in peripheral vascular disease} \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: NOT CI with MAOIs, longest 1/2 life, slower onset of action} \tn 
% Row Count 17 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Naratriptan (Amerge)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1B and 5HT1D agonist active the receptors on the presynaptic trigeminal nerve endings and inhibit the release of vasodilating peptides, also leads to vasoconstriction by preventing the vasodilation and stretching of pain nerve endings. It also inhibits histamine release from mast cells, blocking inflammation in the brain. It can also stimulate 5HT1F receptors on CNV nerve terminals preventing CGRP release.} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: acute migraine managment} \tn 
% Row Count 10 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: oral} \tn 
% Row Count 11 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side effects: dry mouth, paresthesias, dizziness, tachycardia, muscle weakness, triptan sensation} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in severe renal impairment or hepatic impairment} \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Consideration: NOT CI with MAOIs, slower onset of action, longer 1/2 life, better when given prior to an event (like mensuration), unlikely to have drug to drug interactions} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{p{0.50347 cm} x{2.24273 cm} x{1.8308 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Serotonin (5HT) Receptors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Receptor} & Location/Effects & Drugs That Work on Them \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
5HT1A & \seqsplit{hippocampus-regulates} sleep, feeding, and anxiety & Buspirone (agonist) \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{5HT1B}} & Substantia nigra/Basal nuclei- neuronal inhibition & Triptans (agonist) \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
{\bf{5HT1D}} & Brain- vasoconstriction & Triptans (agonist) \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{5HT1F}} & Brain- vasoconstriction, CNS effects & Lasmiditan (Reyvow) \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
5HT2A & Platelets/smooth muscle- muscle contraction &  \tn 
% Row Count 17 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\seqsplit{5HT2B/C} & Stomach- appetite suppression & Lorcaserin (agonist) *off market \tn 
% Row Count 19 (+ 2)
% Row 7
\SetRowColor{white}
5HT4 & CNS, smooth muscle, myenteric neurons & Metoclopramide (agonist) \tn 
% Row Count 21 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Migraine Pathophysiology Review}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The exact pathophysiology is still unknown. It used to be though that migraines were only due to excessive vasodilation of the cranial blood vessels but it is now known to not be the main cause. It is more about {\bf{trigeminal nerve firing and nociception}}} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Involves trigeminal nerve distribution to the cranial arteries. These nerves release peptides (especially calcitonin gene-related peptide CGRP) {\bf{which is a potent vasodilator and increases nociception}}} \tn 
% Row Count 11 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Substance P and Neurokinin A may be involved in the pain response.} \tn 
% Row Count 13 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Malfunctioning of brain areas and channels plays a role.} \tn 
% Row Count 15 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{A wide variety of drugs are used in migraines: triptans, ergots, NSAIDs, BBs, CCBs, TCAs, and CGRP antagoinst.} \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Some are used for acute migraines and some are used for prevention.} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{What is going on at the level of the synapse?}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1682704800_IMG_2032.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Botulinum Toxin (Botox)-Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: inhibits sensory nerve endings, reduces pain signals} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: may be used in patients with 15 or more headaches per month, with headaches lasting for four or more hours per day} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formula: Injection} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: paralysis, facial paralysis} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: FDA approved for chronic migraine, shown to reduce HA by 8 days per month} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Calcium Channel Blockers- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Drugs Used: Nicardipine, Verapamil} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: inhibits inflammation that is caused by trigeminal nerve activation by decreasing calcium influx} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Indications: third line agents} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: hypotension, bradycardia, peripheral edema} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: Peripheral edema, heart blocks} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: OFF LABEL USE, Nicardipine has the best evidence for efficacy} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ACEIs or ARBs- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Drugs Used: Lisinopril and Candesartan} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: proposed MOA is an increase in NE and 5HT action on vascular tone} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Indications: Second or third line, or in patients that need ACEI/ARB for other reason} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formula: Oral} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: hypotension, angioedema, rhabdomyolysis} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in patients with a history of angioedema and pregnancy} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: OFF LABEL USE, caution in renal insufficiency, hyperkalemia} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Venlafaxine er (Effexor XR)- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: increases 5HT levels to help keep cranial blood vessels constricted} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: second line, consider in patients with depression or anxiety} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: oral} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: Nausea, vomiting, drowsiness, dizziness, blurry vision} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with MAOIs within 2 weeks} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: caution in patients with HTN, and seizure disorders} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Valproic Acid/Divalproex- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: increases GABA action (inhibitory NT centrally), suppresses migraine events, slows nociceptive transmission} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: first line, consider using with BB to increase efficacy} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: GI, sleepiness, weight gain, hair loss, tremor, thrombocytopenia, rare hepatotoxicity, caution in liver disease} \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in women that may become pregnant (Teratogenic)} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: FDA approved for migraine prophylaxis} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{TCA (Tricyclic \seqsplit{Antidepressant)-Prophylaxis}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Drugs Used: Amitriptyline} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: inhibits 5HT reuptake (leads to vasoconstriction), decreases excitability, intensifies inhibition on nociceptive pathways} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Indications: first or second line, consider for patients with insomnia or depression, also good for tension type headaches, consider using with BB, topiramate to increase efficacy} \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formulation: oral} \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: anticholinergic effects ({\bf{weight gain}}, blurry vision, constipation, sedation, {\bf{drowsiness}}) arrhythmias} \tn 
% Row Count 13 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindicaitons:} \tn 
% Row Count 14 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Amitriptyline has the most data of the class and the only one FDA approved for this indication} \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Topiramate (Topamax)- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA for migraine prophylaxis: blocks multiple voltage gated channels (Na and Ca2+) leading to decreased excitability, facilitates GABA mediated inhibition, reduces CGRP secretion from trigeminal neurons} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: first line therapy, may be beneficial in chronic migraine (15 or more HA/month), can be used with BB or TCA to increase efficacy.} \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: oral} \tn 
% Row Count 9 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: fatigue, HA, dizziness, nausea, weight loss, glaucoma, metabolic acidosis, kidney stones} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications:} \tn 
% Row Count 13 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Consider in patients worries about weight gain, FDA approved for prophylaxis} \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Beta Blockers- Prophylaxis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Drugs Used: Metoprolol, Propranolol, Timolol (*propranolol and timolol are FDA approved for migraine prevention)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA in migraine prophylaxis: reduces neuronal activity and excitability (decreased NE release), membrane stabilizing} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Indication: considered 1st line agent, especially for patients who already need a BB for another reason (HTN, angina)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Formulation: oral} \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: BB blues, bradycardia, impotence, bronchoconstriction, AV blocks, fatigue, hypotension} \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: Caution in patients with asthma (nonselective), PDV, and heart blocks} \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Can use with TCA, topiramate to increase efficacy} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Lasmiditan (Reyvow) 5HT1F Agonist}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: 5HT1F specific agonist, lacks the vasoconstrictive effects of triptans because it is selective for 1F (suggests if may be safer for cardio), {\bf{overall it reduces trigeminal nerve stimulation}}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: used when patient has failed 2 triptans or are unable to tolerate triptans} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: Oral} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: dizziness, hallucinations, sedation, nausea, vomiting, tachycardia, palpitations, euphoria ({\bf{do not drive for 8 hours post dose}})} \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications:} \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: {\bf{a controlled substance-\textgreater{} CV}}. There is a risk of serotonin syndrome ALONE OR if used in combo with other serotoninergic drugs (SSRIs, ergots, triptans, ect)} \tn 
% Row Count 15 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Serotonin Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The accumulation of too much serotonin in the brain synapses.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Most at risk patients are those on multiple medications that will elevate serotonin levels.} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Watch for drug induced}} (Triptans, antidepressants like SSRIs/SNRIs, cocaine, ondansetron, ect.} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Migraine Pathophysiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Migraine Headaches are most often unilateral (hemiplegic), pulsating, and can last anywhere from 2 hours to 72 hours.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Symptoms include nausea, vomiting, sensitivity to light, sound, and smell, pain is often made worse by physical activity.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Migraines are more common in females and there tends to be a genetic component.} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{There are two types those that are preceded by an aura, and those that are without aura (more common \textasciitilde{}85\%)} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Those that are preceded by an aura experience and sensory episode. There is often burning, itching, numbness, speech problems, visual symptoms, flickering lights, blinds pots, and even vision loss.} \tn 
% Row Count 15 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Those that are not preceded by an aura, usually experience a prodrome of fatigue and irritability.} \tn 
% Row Count 17 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Possible triggers are thought to be increased stress, changes in sleep patterns, and fluctuations in estrogen during the menstrual cycle.} \tn 
% Row Count 20 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Overview}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1682711972_IMG_2033.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ergotamine \seqsplit{tartrate/Dihydroergotamine}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: the fungus releases histamine, Ach, and tyramine. These all affect alpha, dopamine, and 5HT receptors.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: migraine in prodrome, in severe cases} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: sublingual tablet (Ergomar/Cafergot), suppository, IV/IM in severe cases in ED} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: nausea, vomiting, dizziness, abdominal pain, weakness, {\bf{serious if signs of ergotism}}} \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in pregnancy, PDV, severe atherosclerosis, Raynaud's syndrome, CyP3A4 inhibitors (increases levels of ergotamine) (also duh severe vasoconstriction)} \tn 
% Row Count 13 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Provides {\bf{long lasting vasoconstriction}} and it accumulates. Patient education is key for them not to exceed 6mg/attack and no more than 10mg/week} \tn 
% Row Count 17 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ergot Altaloids}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ergot alkaloids are created by the fungus Claviceps purpurea (found on grains)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{MOA: the fungus releases histamine, ACh, tyramine. This affects all alpha, dopamine, and 5HT receptors.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Accidental injection can lead to ergotism. Toxicity leads to hallucinations, vasospasms, can lead to painful ischemia and gangrene.} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{A very potent vasoconstrictor}}} \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{LSD is a synthetic ergot- powerful CNS hallucinogen} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Ergots are not used for analgesic properties in any other condition.} \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ergots are most effective when given during the prodrome. The effectiveness decreases the longer you wait-\textgreater{} {\bf{for acute only}}} \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{not first line, save for severe cases}}} \tn 
% Row Count 17 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Hyperprolactinemia can occur due to secreting tumors of the pituitary of by using DA antagonist. Bromocriptine is used to decrease prolactin levels and also helps in tumor regression. Bromocriptine, Cabergoline, and Pergolide have the highest pituitary DA pituitary DA pituitary receptor affinity of ergots.} \tn 
% Row Count 24 (+ 7)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Parkinson's disease: Bromocriptine (D2 agonist) helps to stop the release of too much prolactin. Rarely used now.} \tn 
% Row Count 27 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{NSAIDs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: reduces pain and inflammation through prostaglandin inhibiton} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: no specific NSAIDs are FDA approved for migraines EXCEPT for {\bf{Cambia}} (diclofenac powder for oral solution) and {\bf{Elyxyb}} (celecoxib oral solution) {\bf{Ibuprofen and Naproxen are most used for mild migraines}}} \tn 
% Row Count 7 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: depends on drug- many avaliable} \tn 
% Row Count 8 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side effects: bleeding risk for patients on blood thinners, stomach ulcers, caution in asthmatics {\bf{celecoxib has a BBW for CV events}}} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in pregnancy after 20 weeks, NSAID allergy, and severe renal impairment} \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: \seqsplit{Acetaminophen/ASA/caffeine=excedrin} (OTC migraine cocktail), APAP and ASA alone can also be tried for OTC migraine management} \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Eptinezumab (Vyepti) CGRP Antibodies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: Blocks the CGRP receptor} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider in patients with inadequate response after an 8 week trial of at least 2 first line oral meds or med combinations at optimal doses, OR if oral non-CGRP medications are not tolerated} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: Infusion given every 3 months in office} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: can be combined with non-CGRP oral medications for acute (ie. triptan, NSAIDs). Information is lacking on taking CGRP antagonist for both acute treatment and prophylaxis.} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Erenumab (Aimovig) -CGRP antibody}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: CGRP receptor blocker} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider in patients with inadequate response after an 8 week trial of at least 2 first line oral meds or med combinations at optimal doses, OR if oral non-CGRP medications are not tolerated} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: autoinjector, SQ once monthly} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: Special warning label for worsening HTN, and Latex allergy} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Considerations: can be combined with non-CGRP oral mediations for acute (Triptans, NSAIDs)} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Fremanezumab (Ajovy)- CGRP Antibody}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: CGRP receptor blocker} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider in patients with inadequate response after an 8 week trial of at least 2 first line oral meds or med combinations at optimal doses, OR if oral non-CGRP medications are not tolerated} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: autoinjector, SQ monthly (1injection), or every 3 months (3 injections at once)} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: can be combined with non-CGRP oral medicaitons.} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Galcanexumab (Emgality)- CGRP Antibody}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: Blocks the CGRP receptor} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider in patients with inadequate response after an 8 week trial of at least 2 first line oral meds or med combinations at optimal doses, OR if oral non-CGRP medications are not tolerated} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulation: Prefilled syringe/or autoinjector, SQ once monthly} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: can be combined with non-CGRP oral medications for acute.} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rimegepant (Nurtec)-CGRP antagonist}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: CGRP is a peptide released from sensory nerves in the brain, it dilates blood vessels and centrally modulates nociception. These medications antagonize this peptide and prevent its dilatory effects. It also decreases nociception response leading to decreased pain.} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider for patients that can't use triptans or have failed 2 triptans} \tn 
% Row Count 8 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: oral dissolving tablet} \tn 
% Row Count 9 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: nausea, hypersensitivity reactions, sedation, dry mouth, abdominal pain/dyspepsia} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI in hepatic impairment, and with CYP3A4 inhibitors or inducers {\bf{look for drug interactions}}} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: Long 1/2 life (11 hours). FDA approved for both prevention (prophylaxis) and treatment. {\bf{Max of 18 doses per month (one tablet qod)}}} \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Ubrogepant (Ubrelvy)- CGRP antagonist}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA: CGRP is a peptide released from sensory nerves in the brain, it dilates blood vessels and centrally modulates nociception. These medications antagonize this peptide and prevent its dilatory effects. It also decreases nociception response leading to decreased pain.} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Indications: consider for a patients that can't use triptans or have failed two triptans. Consider an alternative to injectable CGRP antagonist.} \tn 
% Row Count 9 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Formulations: Oral} \tn 
% Row Count 10 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Side Effects: nausea, hypersensitivity reactions, sedation, dry mouth} \tn 
% Row Count 12 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contraindications: CI with strong CYP3A4 inhibitors {\bf{look for drug interactions}}} \tn 
% Row Count 14 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Considerations: only used for treatment, not used for prevention} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}