Ch. 33- Drugs for HA Flashcards
What is a common trigger for headaches?
Stress, fatigue, acute illness, sensitivity to alcohol
What over-the-counter medications can relieve mild headache episodes?
Aspirin, acetaminophen
Name two types of severe headaches.
Migraine, cluster headaches
What are some identifiable underlying causes of severe headaches?
- Severe HTN
- Hyperthyroidism
- Tumor
- Infection
- Disorders of the eye, nose, sinuses, and throat
What are the characteristics of a migraine headache?
- Throbbing head pain of moderate to severe intensity
- Nausea & vomiting
- Sensitivity to light & sound
- Hormonal component
- Family history typical
- Highly debilitating
What are the two primary forms of migraine headaches?
- Migraine with aura
- Migraine without aura
What is the pathophysiology of migraine headaches?
Neurovascular disorder that involves dilation & inflammation of intracranial blood vessels
What role do calcitonin gene-related peptide (CGRP) and serotonin (5-HT) play in migraines?
- CGRP promotes migraines
- 5-HT suppresses migraines
List some nondrug measures for managing migraines.
- Adequate sleep
- Exercise
- Avoiding triggers
- Dark room with ice pack to neck
What is the goal of abortive therapy for migraines?
Eliminate headache pain & suppress associated nausea/vomiting
What are first-line therapies for aborting an ongoing migraine attack?
- Nonspecific analgesics
- Aspirin-like drugs
- Serotonin 1B/1D receptor agonists (triptans)
What is a common route of administration for abortive migraine medication?
Injection, inhalation, or rectal suppository may be more effective
What are some adverse effects of Serotonin 1B/1D receptor agonists?
- Chest symptoms
- Transient ‘heavy arms’ or ‘chest pressure’
- Coronary vasospasm
- Teratogenesis
- Vertigo, malaise, fatigue, tingling sensations
- Very bad taste when taken in intranasal form
What are some contraindications for using triptans?
- CAD
- Current symptoms of angina
- Ischemic heart disease
- History of MI
- Uncontrolled HTN
What is Lasmiditan (Reyvow)?
A serotonin 1F receptor agonist known as a ditan, does NOT cause vasoconstriction
What are the therapeutic uses of Ergotamine?
Stops an ongoing migraine, second-line therapy in patients that do not respond to a triptan
What is a significant adverse effect of ergotamine?
Nausea/vomiting, weakness in the legs, myalgia, numbness and tingling in fingers or toes
What is Ubrogepant (Ubrelvy)?
First in class approved for acute treatment of migraines, a CGRP receptor antagonist
What is the mechanism of action of Ubrogepant?
Blocks CGRP from attaching to its receptor, decreasing inflammation and pain
What are the first-line drugs for migraine prevention?
- Beta blockers (e.g., Propranolol, Metoprolol)
- Antiepileptic drugs (e.g., Divalproex, Topiramate)
- Tricyclic antidepressants (e.g., Amitriptyline)
What is a menstrually associated migraine?
Migraine that routinely occurs within 2 days of the onset of menses triggered by the decline in estrogen levels
What is the primary therapy for cluster headaches?
Prophylaxis with systemic glucocorticoids, verapamil, lithium
How are cluster headaches characterized?
- Occur in a series or ‘cluster’ of attacks
- Severe, throbbing, unilateral pain near the eye
- Lacrimation, conjunctival redness, nasal congestion
- 1-2 attacks every day for 2-3 months
What is the main treatment for an ongoing cluster headache?
Sumatriptan or oxygen
True or False: Sumatriptan is also approved for cluster headaches.
True
What should a patient avoid when taking ergotamine?
Grapefruit juice
What is the most important instruction for a patient prescribed propranolol for migraine headaches?
Instruct the patient that the medication will help prevent migraines
