Chapter 19: Drugs for Headaches Flashcards
diagnosis of primary headache disorder requires consideration of if the cause is ___ or ___ based
physiological or anatomic
what are symptoms of a tension headache?
bilateral pressing pain/pressure around the head
tension headaches are often caused by __, __ and ___
stress; fatigue; dehydration
the pain caused by a tension headache is often classed as ___
mild to moderate
what are some non-pharm options for a tension headache?
stress-management; good sleep, proper nutrition and hydration
what are the symptoms of a migraine?
aura, nausea, photophobia/phonophobia, sensitivity to smell, worsen w/movement
the pain level of a migraine is ___ to ___
moderate to severe
one major difference between tension headaches and migraines is that the pain in a migraine is described as ___
throbbing, usually unilateral
what are the 2 classifications of migraine headache?
with aura, w/o aura
diagnosis of a migraine headache usually requires the presence of at least 1 ___ type symptom
sensory
___ and ___ OTC products are the most popular treatments for migraine and tension headaches
analgesic and anti-inflammatory
t/f it is important for patients to avoid headache triggers
t
what is the purpose of a headache diary?
helps track source/ trigger of headaches as well as the details of symptoms that can help diagnose
what are some common food triggers for a headache?
alcohol, caffeine, chocolate, aged cheese, processed foods/additives
what are some physiologic triggers of a headache?
dehydration, fatigue, stress, weather, bright lights, mestruation
a migraine headache is generally described as a ___ condition occurring in __ (#) phases
neuromuscular; 2
what happens in the first phase of a migraine?
vasoconstriction causes schema and serotonin release
what happens in the second phase of a migraine?
neuropeptides released from the trigeminal nerves cause vasodilation, inflammation and transmission of pain
abortive therapies for migraines often involve trying to reduce ___nerve dilation and reduce release of ___ and ___ mediators
cranial; pro inflammatory and pain
for more severe headaches that cannot resolved by NSAIDs and acetaminophen, a class of drugs called ___are used
triptans
___ are the most commonly prescribed drugs for migraine patients
triptans
before triptans, the use of ___ or ___ for migraine treatment was common, but now reserved for severe cases
opioids; ergot alkaloids
acute management of migraine with ___ is the last resort due to ADR and risk of abuse/addiction
opioids
ergot alkaloids (like DHE) can cause nausea, so they are often given with a ____ like ___
antiemetic like metoclopramide
ergot alkaloids are a group of compounds originally isolated from a___
fungus that grows on grain
ergot alkaloids were used in the 1800’s as ___
anticoagulants to stop bleeding
ergot alkaloids act as ___
vasoconstrictors
what are 4 ergot derivatives?
ergotamine, LSD, bromocriptine, dihydroergotamine
ergotamine has significant __ activity, but many additional physiologic effects due to agonist activity at several___ receptors
monoamine
the hallucinogenic actions of LSD are related to stimulation of ___ in the CNS
serotonin receptors
t/f bromocrpitine and dihydroergotamine are ergot derivatives that can be used clinically
t
bromocriptine has a higher affinity for ____ receptors, making it useful in treatment of parkinsons
DA
dihydroergotamine has a higher affinity for ____ receptors, leading to its use in migraines
serotonin
what are some ADRs of ergot alkaloids?
nausea and hallucinations
ergot alkaloids are contraindicated in what patients?
those pregnant and those with CVD (vasoconstriction)
___ were the primary treatment for migraines from 1930’s-90’s despite their many off-target effects
ergot alkaloids
the specific serotonin receptor in the cranial blood vessels is the ___ receptor
5-HT 1B
t/f the 1D and 5-HT 1B serotonin receptors are very similar and are typically grouped together
t
___ was the 1st triptan class drug that came to market in the early 1990’s
sumatriptan
the chemical structure of sumatriptan is more closely related to ___ compared to DHE
serotonin
sumatriptan is a more selective agonist for ___ and ___ receptors
5-HT 1B and 1D
what is one of the most notable benefits if using sumatriptan for migraine treatment over ergots?
doesn’t bind to adrenergic or dopamine receptors so less ADRs
the pathophysiology of a migraine is considered to be a __ problem
vascular
agonism of ___ receptors is thought to be the primary action of triptans in migraine treatment
5-HT 1d/b
what is the vascular theory of migraine?
vasoconstriction resolves migraine and vasodilation is likely to cause migraine
t/f despite the vascular theory, brain imaging has shown that vasodilation of the cranial nerve does not necessarily cause a migraine and migraines can occur w/o dilation of cranial nerves
t
the neurogenic inflammation theory of migraines suggests a prominent role of ___ as the cause of cranial vessel dilation, inflammation, and promotion of pain signal
neuropeptides
the neurogenic inflammation theory of migraines suggests that if release of ___ is blocked / reduced, the migraine pain should reduce
neuropeptides
neuropeptides release along with NT in response to opening of ____ channels and AP are carried through the postsynaptic neuron
voltage gated ca
1D and 1B serotonin receptors on the presynaptic neuron have what function?
reduces the activation of Ca channels that cause the release of Nt and neuropeptide that lwould lead to migraine pain
what is the primary NT released in the CNS>
glutamate
give 2 examples of neuropeptides that are released and cause the vasodilation and release of pro-inflammatory mediators in migraine
CGRP and substance P
stimulation of 5-HT 1d/b receptors by ergots and triptans causes ___
inhibition of Ca channels, reducing the release of NT/ neuropeptides that would cause migraine pain
MOA of Erenumab
monoclonal antibody that blocks the activation of the postsynaptic CGRP receptor so it cannot respond to the CGRP sent by the presynaptic neuron (blocks pain transmission)
t/f Erenumab is a new drug, but clinical trial showed patients experience fewer migraines on this treatment
t
Erenumab is given as a monthly injection, making it a ___ migraine treatment unlike the abortive therapy of triptans
prophylactic
t/f CGRP has been shown t be an important mediator of migraines
t
prevention of neuropeptide actions on the cranial blood vessels reduces ___, ___ and activation of ____ nerves
vasodilation; inflammation; trigeminal
it is recommended that migraine abortive therapies be used less than ___ days month
10
t/f there is not likely one central mechanism for a medication overuse headache
t
t/f with a medication overuse headache, the patient may experience headache more often than they had b/4 treatment
t
proposed mechanisms for overuse headache include alterations in the ___ pathways leading to increased excitability and increased ___ release such as CGRP
trigeminal nerve; neuropeptides
if a patient needs abortive headache treatment more 10 days a month, what should their treatment be changed to?
preventative (prophylactic) treatment
prophylactic strategies for migraine include reducing early phase ___, increasing levels of ___
vasoconstriction; serotonin (w/ antidepressants)
give examples of drugs that can be used as migraine prophylactic agents
B-blockers, tricyclic anti-depressants, Ca channel blockers, botox injections, SSRIs, Erunemab
prophylactic headache treatments are often tirade for ___ months
2-3
prophylactic headache treatment is often tapered off after ___ months to determine if its still needed
6-12
___ in red wines can trigger migraines in some patients
tannins
