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Simmons NURP 503 Exam 1 > 1: Migraines > Flashcards

1: Migraines Flashcards

1
Q

What is the dose for topiramate (Topamax)?

A

25 mg BID.

200 mg doses max.

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2
Q

Which tricyclic is used to prevent migraines?

A

Amitriptyline
Often used at bedtime.
10-25 mg qPM
Can titrate up to 150 mg daily (max 400 mg daily).

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3
Q

Diagnostic criteria for migraines.

A 
Repeated attacks lasting 4–72 hours
Normal neuro exam
No other reasonable cause for headache
At least two of the following:
-Unilateral pain (~60% of the time)
-Throbbing/pulsating pain
-Aggravation by movement or activity
-Moderate to severe intensity
Plus at least one:
-Nausea and vomiting
-Photophobia or phonophobia
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4
Q

What is the #1 recommended preventative med?

A

Propanolol

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5
Q

How long do auras typically last?

A

30-60 minutes

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6
Q

What is the dose for valproic acid?

A

250 mg 2-3x daily.

Titrate up to effectiveness.

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7
Q

What are the first-line preventative meds with low efficacy (3)?

A

Cyproheptadine
Gabapentin
Lamotrigine

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8
Q

What are the 2 general types of treatment for migraines?

A

Abortive

Preventative

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9
Q

T/F Early migraine treatment that includes a single, large dose is most effective.

A

True

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10
Q

Are migraines more common in men or women?

A

Women. 20-25% of women and 8-10% of men.

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11
Q

Name 2 combination drugs for migraines.

A

Sumatriptan + naproxen (Treximet)

Acetaminophen + butalbital (sedative) + caffeine (Fioricet)

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12
Q

What are the second-line preventative meds with high efficacy (3)?

A

Methysergide
Flunarizine
MAOIs

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13
Q

T/F With migraines, the focus should be on a cure.

A

False. Focus should be on adequate control, not a cure.

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14
Q

T/F CCBs may relieve migraine auras but are not as effective as BBs.

A

True

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15
Q

What are the first-line preventative meds with high efficacy (4)?

A

BB
Tricyclics
Valproate (anticonvulsant)
Topiramate (anticonvulsant)

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16
Q

What are the first-line preventative meds with low efficacy (3)?

A

Verapamil
NSAIDs
SSRIs

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17
Q

What are possible tolerance issues with propanolol?

A

Bradycardia

Low blood pressure

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18
Q

What is a major concern when using valproic acid (VPA) or topiramate?

A

Black box warning of suicide risk for those with major depression disorders.

19
Q

T/F Preventative treatment provides relief in approximately 4 weeks.

A

False. May take up to 8-12 weeks to have noticeable effect.

20
Q

Severe migraine can lead to _____ and may necessitate IV. Nausea or vomiting may require an IV as well.

A

Severe migraine can lead to gastric stasis and may necessitate IV. Nausea or vomiting may require an IV as well.

21
Q

What percentage of migraine sufferers have an aura?

A

20%

22
Q

T/F Amitriptyline may cause insomnia.

A

True

23
Q

T/F Tension-type headache is more common, but migraine is more often presented in primary care for treatment.

A

True

24
Q

How do triptans work to abort migraines?

A

Promote vasoconstriction.

Block pain pathways to brain.

25
Q

What is the treatment for severe migraines that are incapacitating?

A

Go to ED for IV treatment.

26
Q

T/F Aura symptoms can be both negative and positive in the beginning.

A

False. Typically begin with positive symptoms (scintillation or parasthesia) and negative symptoms comes later (numbness, aphasia, scotoma).

27
Q

Name abortive treatments (4).

A

NSAIDs
Acetaminophen
Aspirin
Triptans

28
Q

What is the most commonly used CCB and what is the dose?

A

Verapamil
Start with 80 mg 3-4x daily.
720 mg daily max.

29
Q

What are indications for preventative treatment (4)?

A

Overuse of abortive treatment.
Different types of migraines.
Frequent migraines.
Long-lasting pain, causing significant disability.

30
Q

What are 7 examples of foods that trigger migraines?

A 
Chocolate
Cheeses
Fried foods
Nitrites
Red wine
Oranges
Hot dogs
31
Q

_____ treatment should be aggressive. _____ treatment should start low and go slow.

A

Abortive treatment should be aggressive. Preventative treatment should start low and go slow.

32
Q

What additional treatments would be considered for moderate migraines that inhibit daily activities but are not incapacitating?

A

Triptan combinations
Consider regular, preventative treatment
Antiemetics for n/v

33
Q

Name the triptans listed in asynch (3).

A

Sumatriptan (Imitrex)
Naratriptan (Amerge)
Zolmitriptan (Zomig)

34
Q

Name abortive treatments for mild symptoms with minimal alteration in daily routine.

A

OTCs (Tylenol, ASA, NSAIDs)
Excedrin (with caffeine)
Triptans

35
Q

What happens if a patient develops tolerance to CCBs?

A

Switch to another CCB.

36
Q

T/F Preventative treatment should not be discontinued without a taper.

A

True

37
Q

If response to preventative migraine treatment is too mild, what do you do?

A

Increase dose or add 2nd agent

38
Q

What is the starting dose for preventative treatment with propanolol?

A

Start with 10-20 mg 2-3x daily.
Can increase to 240 mg daily.
Available as extended release, too.

39
Q

Which NSAIDs work best with migraines?

A

There is no data comparing efficacy of different NSAIDs.

40
Q

T/F Auras are mostly visual.

A

True

41
Q

Do migraines begin at an earlier age in men or women?

A

Men

42
Q

T/F There is no data to support the use of SSRIs in preventing migraines.

A

True

43
Q

Name 14 common migraine triggers.

A 
Change in weather
Stress
Alcohol
Hunger
Fatigue/lack of sleep
Loud noises
Flickering lights
Noxious stimuli
Foods
Exertion
Nitroglycerin
Minor head trauma
Menses
Surgical menopause
44
Q

How can you figure out migraine triggers?

A

Headache diary

Simmons NURP 503 Exam 1 (34 decks)

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