<prompt> All are true about treatment of migraine EXCEPT:Naratriptan acts longer than sumatryptanSumatryptan is used in acute attack of migraineSumatryptan acts on 5HT. BD receptors in great vesselsSumatryptan is used for chronic migraine  <response>: ANSWER: D Sumatryptan is used for chronic migraineREF: Harrisons 17th ed chapter 15By chronic migraine the examiner means to say prevention of migraine and sumatryptan is not used in prevention of migraine, but in acute attackNaratriptan, administered orally, reaches its peak plasma concentration in 2-3 hours and has an absolute bioavailability of -70. It is the longest acting of the triptans, having a tl2 of -6 hours. REF: Goodman Gillman 11th edition page 196Most drugs effective in the treatment of migraine are members of one of three major pharmacologic classes: anti-inflammatory agents, 5HT1B1D receptor agonists, and dopamine receptor antagonists.Treatment of Acute migraineDrugTrade NameDosageSimple Analgesics Acetaminophen, aspirin, caffeineExcedrin migraineTwo tablets or caplets q6h max 8 per dayNSAIDs NaproxenIbuprofenAleve, Anaprox, generic Advil. Motrin, Nuprin, generic220-550 mg PO bid400 mg PO q3-4hTolfenamic addClotam Rapid200 mg PO. May repeat x 1 after 1-2 h5-HT1 Agonists Oral ErgotamineErgomarOne 2 mg sublingual tablet at onset and q 12 ,,h max 3 per day, 5 per weekErgotamine 1 mg, caffeine 100 mgErcaf, WigraineOne or two tablets at onset, then one tablet q 12 h max 6 per day, 10 per weekNaratriptanAmerge2.5 mg tablet at onset; may repeat once after 4 hRizatriptanMaxaltMaxalt-MLT5-10 mg tablet at onset; may repeat after 2 h max 30 mgdSumatriptanImitrex50-100 mg tablet at onset; may repeat after 2 h max 200 mgdFrovatriptanFrova2.5 mg tablet at onset, may repeat after 2 h max 5 mgdAlmotriptanAxert12.5 mg tablet at onset, may repeat after 2 h max 25 mgdEletriptanRelpax40 or 80 mgZolmitriptanZomigZomig Rapimelt2.5 mg tablet at onset; may repeat after 2 h max 10 mgdNasal DihydroergotamineMigranal Nasal SprayPrior to nasal spray, the pump must be primed 4 times; 1 spray 0.5 mg is administered, followed in 15 min by a second spraySumatriptanImitrex Nasal Spray5-20 mg intranasal spray as 4 sprays of 5 mg or a single 20 mg spray may repeat once after 2 h, not to exceed a dose of 40 mgdZolmitriptanZomig5 mg intranasal spray as one spray may repeat once after 2 h, not to exceed a dose of 10 mgdParenteral DihydroergotamineDHE-451 mg IV, IM, or SC at onset and qlh max 3 mgd, 6 mg per weekSumatriptanImitrex Injection6 mg SC at onset may repeat once after 1 h for max of 2 doses in 24 hDopamine Antagonists Oral MetoclopramideReglan,generic5-10 mgdProchlorperazineCompazine, generic1-25 mgdParenteral ChlorpromazineGeneric0.1 mgkg IV at 2 mgmin; max 35 mg dMetoclopramideReglan, generic10 mg IVProchlorperazineCompazine, generic10 mg rvOther Oral Acetaminophen,325 mg, plus dichloralphenazone, 100 mg, plus isometheptene, 65 mgMidrin, Duradrin, genericTwo capsules at onset followed by 1 capsule qlh max 5 capsulesNasal ButorphanolStadol1 mg 1 spray in 1 nostril, may repeat if necessary in 1-2 hParenteral NarcoticsGenericMultiple preparations and dosagesPrevention of MigraineDrugDoseSelected Side EffectsPizotifen0.5-2 mg qdWeight gainDrowsinessBeta blocker Propranolol40-120 mg bidReduced energyTirednessPostural symptomsContraindicated in asthmaTricyclics Amitriptyline10-75 mg at nightDrowsinessDothiepin25-75 mg at night Nortriptyline25-75 mg at nightNote: Some patients may only need a total dose of 10 mg, although generally 1-1.5 mgkgbody weight is requiredAnticonvuls ants Topiramate25-200 mgdParesthesiasCognitive symptomsWeight lossGlaucomaCaution with nephrolithiasisValproate400-600 mg bidDrowsinessWeight gainTremor Hair lossFetal abnormalitiesHematologic or liver abnormalitiesGabapentin900-3600 mg qdDizzinessSedationSerotonergic drugs Methysergide1-4 mg qdDrowsinessLeg crampsHairlessRetroperitoneal fibrosis 1-month drug holiday is required every 6 monthsFlunarizine5-15 mg qdDrowsinessWeight gainDepressionParkinsonism 