12) Headaches Flashcards
What is the mechanism for Analgesics
Inhibition of COX (COX2 may be preferential)
What are the therapeutics for Analgesics
Acute treatment of moderate migraine (combination of acetaminophen, aspirin, and caffeine); acute treatment of tension headaches
What are the therapeutics for Barbiturates
Acute treatment of migraines; use when more traditional therapies unavailable or contraindicated
What are the important side effects for Barbiturates
Drowsiness, dizziness
What are the miscellaneous for Barbiturates
Use limited to 2-3 times per week
What are the therapeutics for Opioids
Acute treatment of migraines; patients with infrequent headaches; generally, for patients who wake up with a headache
What are the miscellaneous for Opioids
Use less than 2 days per week; pregnant women may use codeine or meperidine with caution
What are the therapeutics for Corticosteroids
Acute treatment of migraines; migraine, prolonged headache syndromes (e.g., chronic daily headache); rescue treatment of cluster headache
What are the miscellaneous for Corticosteroids
Chronic medicaton/overuse most common cause of chronic daily headaches
What is the mechanism for Ergotamines
Vasoconstriction possibly; may also act as a 5HT agonist in trigeminovascular pathway
What are the therapeutics for Ergotamines
Acute treatment of migraines
What are the important side effects for Ergotamines
Nausea, dizziness, paresthesia, chest pain, abdominal cramps
What are the miscellaneous for Ergotamines
Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease
What is the mechanism for DHE (Migranal)
Vasoconstriction possible; mainly act as a 5HT agonist in trigeminovascular pathway
What are the therapeutics for DHE (Migranal)
Acute treatment of migraines; less likely to cause rebound headache than ergotamines; acute treatment of cluster headaches; short-term prevention of cluster headaches (along with steroids)
What are the important side effects for DHE (Migranal)
Nausea (less likely than ergotamines), dizziness, paresthesia, chest pain, abdominal cramps
What are the miscellaneous for DHE (Migranal)
Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; injectable
What is the class for Sumatriptan (Imitrex)
Triptans
What is the mechanism for Sumatriptan (Imitrex)
Selective 5HT1b-d agonists; penetration of CNS, constriction of extracerebral intracranial vessels, inhibition of trigeminovascular system
What are the therapeutics for Sumatriptan (Imitrex)
Acute treatment of migraines (premier option); also effective for photo/phonophobia, nausea and vomiting; acute treatment of cluster headaches
What are the important side effects for Sumatriptan (Imitrex)
Flushing, tingling, dizziness, chest discomfort (noncardiac)
What are the miscellaneous for Sumatriptan (Imitrex)
Contraindicated in vascular disease (including Prinzmetal), uncontrolled HTN, complicated migraine; injectable (suma)
What is the mechanism for Onabotulinum toxin (Botox)
Unknown (possibly decreased afferent stimulation of trigeminovascular system, or downregulation of sensory and parasympathetic receptors)
What are the therapeutics for Onabotulinum toxin (Botox)
Acute treatment of chronic migraine headaches
What are the other side effects for Onabotulinum toxin (Botox)
Injection site pain, headache, neck weakness, ptosis
What are the therapeutics for TCA
Migraine prevention, tension headache prevention
What are the important side effects for TCA
Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
What are the miscellaneous for TCA
Amitriptyline, protriptyline, nortriptyline
What are the therapeutics for SSRIs
Migraine prevention, tension headache prevention
What are the important side effects for SSRIs
Weight gain, sexual dysfunction, headache
What are the miscellaneous for SSRIs
Fluoxetine, paroxetine, sertraline
What are the therapeutics for Beta-blockers
Migraine prevention (only propranolol and timolol FDA approved)
What are the important side effects for Beta-blockers
Drowsiness, depression, decreased libido, hypotension, memory disturbance
What are the miscellaneous for Beta-blockers
Propranolol, timolol, nadolol, atenolol; contraindicated in asthma, diabetes, CHF, or Raynaud’s
What are the therapeutics for Calcium Channel Blockers
Migraine prevention; particularly useful in prolonged or disabling aura, or complicated migraine syndromes (e.g., hemiplegic migarine); long-term prevention of cluster headaches
What are the important side effects for Calcium Channel Blockers
Constipation, dizziness
What are the miscellaneous for Calcium Channel Blockers
Verapamil most commonly used
What are the therapeutics for Oxygen
Acute treatment of cluster headaches
What are the miscellaneous for Oxygen
Rebound can occur when oxygen stopped
