12) Headaches Flashcards

1
Q

What is the mechanism for Analgesics

A

Inhibition of COX (COX2 may be preferential)

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2
Q

What are the therapeutics for Analgesics

A

Acute treatment of moderate migraine (combination of acetaminophen, aspirin, and caffeine); acute treatment of tension headaches

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3
Q

What are the therapeutics for Barbiturates

A

Acute treatment of migraines; use when more traditional therapies unavailable or contraindicated

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4
Q

What are the important side effects for Barbiturates

A

Drowsiness, dizziness

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5
Q

What are the miscellaneous for Barbiturates

A

Use limited to 2-3 times per week

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6
Q

What are the therapeutics for Opioids

A

Acute treatment of migraines; patients with infrequent headaches; generally, for patients who wake up with a headache

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7
Q

What are the miscellaneous for Opioids

A

Use less than 2 days per week; pregnant women may use codeine or meperidine with caution

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8
Q

What are the therapeutics for Corticosteroids

A

Acute treatment of migraines; migraine, prolonged headache syndromes (e.g., chronic daily headache); rescue treatment of cluster headache

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9
Q

What are the miscellaneous for Corticosteroids

A

Chronic medicaton/overuse most common cause of chronic daily headaches

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10
Q

What is the mechanism for Ergotamines

A

Vasoconstriction possibly; may also act as a 5HT agonist in trigeminovascular pathway

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11
Q

What are the therapeutics for Ergotamines

A

Acute treatment of migraines

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12
Q

What are the important side effects for Ergotamines

A

Nausea, dizziness, paresthesia, chest pain, abdominal cramps

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13
Q

What are the miscellaneous for Ergotamines

A

Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease

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14
Q

What is the mechanism for DHE (Migranal)

A

Vasoconstriction possible; mainly act as a 5HT agonist in trigeminovascular pathway

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15
Q

What are the therapeutics for DHE (Migranal)

A

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)

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16
Q

What are the important side effects for DHE (Migranal)

A

Nausea (less likely than ergotamines), dizziness, paresthesia, chest pain, abdominal cramps

17
Q

What are the miscellaneous for DHE (Migranal)

A

Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; injectable

18
Q

What is the class for Sumatriptan (Imitrex)

19
Q

What is the mechanism for Sumatriptan (Imitrex)

A

Selective 5HT1b-d agonists; penetration of CNS, constriction of extracerebral intracranial vessels, inhibition of trigeminovascular system

20
Q

What are the therapeutics for Sumatriptan (Imitrex)

A

Acute treatment of migraines (premier option); also effective for photo/phonophobia, nausea and vomiting; acute treatment of cluster headaches

21
Q

What are the important side effects for Sumatriptan (Imitrex)

A

Flushing, tingling, dizziness, chest discomfort (noncardiac)

22
Q

What are the miscellaneous for Sumatriptan (Imitrex)

A

Contraindicated in vascular disease (including Prinzmetal), uncontrolled HTN, complicated migraine; injectable (suma)

23
Q

What is the mechanism for Onabotulinum toxin (Botox)

A

Unknown (possibly decreased afferent stimulation of trigeminovascular system, or downregulation of sensory and parasympathetic receptors)

24
Q

What are the therapeutics for Onabotulinum toxin (Botox)

A

Acute treatment of chronic migraine headaches

25
What are the other side effects for Onabotulinum toxin (Botox)
Injection site pain, headache, neck weakness, ptosis
26
What are the therapeutics for TCA
Migraine prevention, tension headache prevention
27
What are the important side effects for TCA
Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
28
What are the miscellaneous for TCA
Amitriptyline, protriptyline, nortriptyline
29
What are the therapeutics for SSRIs
Migraine prevention, tension headache prevention
30
What are the important side effects for SSRIs
Weight gain, sexual dysfunction, headache
31
What are the miscellaneous for SSRIs
Fluoxetine, paroxetine, sertraline
32
What are the therapeutics for Beta-blockers
Migraine prevention (only propranolol and timolol FDA approved)
33
What are the important side effects for Beta-blockers
Drowsiness, depression, decreased libido, hypotension, memory disturbance
34
What are the miscellaneous for Beta-blockers
Propranolol, timolol, nadolol, atenolol; contraindicated in asthma, diabetes, CHF, or Raynaud's
35
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
36
What are the important side effects for Calcium Channel Blockers
Constipation, dizziness
37
What are the miscellaneous for Calcium Channel Blockers
Verapamil most commonly used
38
What are the therapeutics for Oxygen
Acute treatment of cluster headaches
39
What are the miscellaneous for Oxygen
Rebound can occur when oxygen stopped