4 - Headaches

Question 1

When do migraines usually develop?

Answer 1

In the morning after awakening

Question 2

What percentage of migraine patients have auras?

Answer 2

Only 30%

Question 3

Migraines always involve _____ and _____

Answer 3

Vasodilation and Inflammation

Question 4

The role of ______ compound is to suppress migraines

Answer 4

Serotonin (5HT)

Question 5

The role of _____ compound is to promote migraines

Answer 5

Calcitonin Gene-related Peptide (CGRP)

Question 6

What is MOH?

Answer 6

Medication Overuse Headaches

Question 7

How often should abortive medications be taken?

Answer 7

1-2 times per week MAX

Otherwise will cause MOH or rebound headache

Question 8

Which NSAIDs work best for migraines?

Answer 8

Aspirins

Tylenol should only be used in combination with other things (Excedrin)

Question 9

Aspirin works best when combined with ______

Answer 9

Reglan

When given together its as effective as sumatriptan

Question 10

What opioid analgesic is used for migraines?

Answer 10

Butorphanol Nasal Spray

Question 11

What are triptans?

Answer 11

Serotonin receptor agonists

Question 12

What is the MOA of triptans?

Answer 12

Bind to Serotonin 1B/1D receptors, suppressing the release of CGRP, and thereby reducing inflammation and vasodilation

Question 13

Triptans exclusively activate _______ receptors

Answer 13

Serotonin_1B/1D

They have NO AFFINITY for other serotonin receptors, and they don’t bind to any adrenergic/dopaminergic/cholinergic/histaminergic receptors

Question 14

Is sumatriptan abortive or prophylactic?

Answer 14

Abortive

Question 15

About 50% of patients who take sumatriptan experience:

Answer 15

unpleasant chest symptoms

These are NOT ischemic in nature

Heavy arms or chest pressure

Question 16

In which patients should sumatriptan not be used?

Answer 16

CAD and Pregnancy (teratogenic)

Question 17

Which drugs should not be given with sumatriptan?

Answer 17

Other triptans or ergots

MAOIs

SSRIs/SNRIs (may cause serotonin syndrome)

Question 18

What is the MOA of Ergot Alkaloids?

Answer 18

Alters transmission at serotonergic, dopaminergic, and Alpha adrenergic junctions

Question 19

Withdrawal from ergotamine is characterized by:

Answer 19

headache, N/V, restlessness… basically, looks just like a migraine attack

Question 20

What is the first line drug for migraine prevention?

Answer 20

Beta blockers, particularly propranolol and metoprolol

Question 21

Which beta blockers are NOT effective in preventing migraines?

Answer 21

The ones that possess sympathomimetic activity:

Acebutolol, Pinolol

Question 22

Which antiepileptic drugs are used to prevent migraines?

Answer 22

Divalproex and Topiramate

Question 23

Divalproex carries a black box warning for:

Answer 23

fatal pancreatitis and hepatitis

Neural tube defects in the fetus

Question 24

There are five classes of drugs used to prevent migraines:

Answer 24

1. Beta Blockers
2. Antiepileptics
3. Tricyclics
4. Estrogens
5. CGRP Antagonists

Question 25

What is Erenumab?

Answer 25

CGRP receptor antagonist

Question 26

What is the MOA of erenumab

Answer 26

It's an IgG monoclonal antibody that binds and antagonizes CGRP receptors

Question 27

Which type of headache occurs primarily in females? Which occurs primarily in males?

Answer 27

Females: Migraines Cluster headaches: Males

Question 28

What is the first line agent for preventing cluster headaches?

Answer 28

Verapamil

Question 29

Which medications can cause MOH?

Answer 29

Almost all the medicines used to abort headaches (EXCEPT dihydroergotamine)