For boards... -triptans... migraine prophylaxis? acutely? both or neither?

[omn]

For boards... -triptans... migraine prophylaxis? acutely? both or neither?

Can someone cite the standard, because I am reading several different things.. is this a testable topic?

Sumatriptan doesn't work on acute migraine symptoms, but is an effective prophylaxis? Are you sure?

This "THREAD" doesn't seem okay to me ....

http://forums.studentdoctor.net/threads/migraine-prophylaxis.284826/

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[kchan99]

What boards, USMLE, ABPN, ABIM....?
Triptans are indicated for acute treatment. For a starting reference, read the prescribing info.

 

[omn]

Really, you don't say.. well, in this type of discourse the aim is normally furthering clarification, not impeding it... but having said that, I think this has something to do with absorption, oral sumatriptan, Imitrex, isn't fast enough? But I'm not sure.

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[kchan99]

Triptans are available in nasal spray and injectable forms if speed is of concern. However, choice of triptan and route of administration are dictated by the patient's insurance unless the patient willing to pay $$$. There are a couple of oral triptans with even slower onset of action and longer duration of action. Some patients actually prefer a longer duration of headache relief.

 

[omn]

what about the fact that there's no diagnosis of Cushing disease with high dose dexamethasone anymore...? is this true, ..? for board question purpose (and i assume current recommendations)... a pituitary ACTH-producing tumor is diagnosed with MRI, then even Petrosal sampling ?

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[kchan99]

I'm not sure how a MRI can diagnose a specific type of tumor. MRI may suggest, and you would still need to correlate clinically and pathologically. For example, I've had patients with supratentorial tumors that looked low-grade on MRI less than a month before biopsy or resection, but it was GBM (WHO Grade IV) or anaplastic astrocytoma (WHO Grade III).

Although the pituitary is within the cranial vault, many neurologists aren't comfortable with endo workups. Endo is consulted. I don't think petrosal blood sampling is done these days. Pathology with H&E, other histochemical stains, and/or immunohistochemistry is used to determine type of pituitary adenoma. I don't know what to say about the USMLE.

 

[omn]

Thanks for your helpful thoughts