18 - Headache in Adults Flashcards
non-pharms
avoid triggers, rest in dark, quiet room if possible, apply headache to area, headache diary to track everything
What are the max doses of abortive meds to avoid MOH ?
- Simple analgesics < 15 days/month (ibuprofen, acetaminophen, naproxen)
- Opioids or combo meds, triptans, ergots < 10 days/month
se/ of ergots?
flushing, tingling, chest pain
MOA of triptans
5-HT 1B and 1D agonists
-supposed to prevent vasoconstriction
What triptan has fastest onset of action?
SC sumatriptan
What triptan has the slowest onset of action?
naratriptan (max efficacy at 4 hours)
When should a person take a triptan?
at onset of headache pain
*taking at aura may be too early
s/e of triptans?
chest discomfort, fatigue, dizziness, flushing
What can patients use for nausea and vomiting associated with migraines?
- Antinauseants (dimenhydrinate)
- Antiemetic/Prokinetic agents (metoclopramide and domperidone) - these ones are also useful to facilitate absorption of some meds
*best evidence for metoclopramide
Prophylactic Therapy:
-Treat for how long at therapeutic dose before assessing benefit?
2 months
Prophylactic Therapy:
What is success defined as?
> 50% reduction in headache frequency or days with headache
Prophylactic Therapy:
If it is deemed beneficial at 2 months, continue for how long?
6-12 months, then consider tapering the dose to assess ongoing need
Do not use ergots within ___ hours of triptan
12 (24 if it’s naratriptan)
Do not use triptans within ___ hours of an ergot
24
List some options for prophylaxis
- Beta blockers (propranolol, metoprolol, nadolol, timolol)
- TCAs (amitriptyline, nortriptyline)
- SNRIs (venlafaxine)
- CCBs (verapamil, flunarizine)
- ACEis (lisinopril) - limited evidence
- ARBs (candesartan)
- Antiepileptics (VPA, topiramate, little evidence for gabapentin)
- Serotonin antagonists (pizotifen at max dose)
- Lithium
- Botox
