Day 4- Headaches and PBA Flashcards
What are our theories on where migraines come from?
What are premonitory symptoms?
What things to know about Aura’s?
Vascular change, Trigeminovascular, Neuronal dysfunction, Serotonin neurotransmission.
Neurologic, Psychological, Autonomic, Constitutional.
Evolves over 5-20 minutes but lasts than 60 minutes. Visual aura’s are most common.
What are some nonpharmacologic treatment for migraines?
What do you need to know about your simple analgesics?
What do you need to know about opiate analgesics?
Apply ice to head, rest in dark quiet area, avoid triggers, general wellness program(regular sleep, exercise, health eating habits, smoking cessation, limit caffeine intake), relaxation techniques.
first line for mild to moderate migraine. Lack of evidence for acetaminophen monotherapy.
USE FOR TREATMENT IS CONTROVERSIAL. No vasopressor or anti-inflammatory effects. Only used in moderate to severe infrequent headaches and conventional therapies are ci’d. Rescue medicine.
Can dopamine agonists be used as monotherapy to treat headaches?
What things do you need to know about ergot alkaloids?
What are your common ergot alkaloid ADR’s?
Yes. Used in intractable migraine.
Nonselective 5-HT1 receptor agonist. Restricts blood vessels and inhibits inflammation in trigeminovascular system. Moderate-severe migraine attacks.
N/V is most common, should give an antiemetic before administration(especially with IV).
What are your severe ergot alkaloid ADR’s?
When are the ergot alkaloid CI’d?
What are your dose limits for the ergots?
Peripheral ischemia(could develop into gangrene). Watch for MI, hepatic necrosis, bowel and brain ischemia.
Use within 24 hours of triptans.
Oral and sublingual tartrate is 6mg/day or 10 mg/week. Dihydroergotamine is 3mg/day or 6 mg/week injection.
What is the triptans MOA?
Which triptans have the longest half life?
Which triptan has the quickest Tmax?
Selective serotonin agonists. 1st line for mild to severe migraines. Rescue therapy when nonspecific medicines fail.
Frova and Naratriptan.
Sumatriptan Subq.
What are some common ADR’s of the triptans?
What are your triptan CI’s?
What are your big drug interactions with the triptans?
Paresthesias, flushing, injection site reactions, triptan sensations(chest tightness, heaviness, pressure, pain).
Use within 24 hours of ergotamine derivatives. If they have hemiplegic and basilar migraine, pregnancy, heart problems.
MAOI’s, CYP3A4 inhibitor, SSRI’s or SNRI’s could cause serotonin syndrome.
When do you consider migraine prophylaxis?
When can you use beta blockers for prophylaxis?
When can you use antidepressants for prophylaxis?
Migraines >2 times per week. Symptomatic treatments aren’t effective or they are CI’d, patient preference. Clinical benefit seen in 2-3 months, max benefit around 6 months, start low go slow, continue 6-12 months after therapeutic effect seen.
Patients with comorbid hypertension. Most data is with metoprolol, propanolol, timolol.
Useful in depression or insomnia(TCA’s), Most data(Amitriptyline, Venlafaxine).
When to use Anti Convulsants for prophylaxis?
When do you want to use NSAIDS for prophylaxis?
What is a good supplement for migraine prophylaxis?
Seizures, bipolar disorder. Most data is Valproic Acid, Topiramate.
useful in migraines with a predictable pattern(naproxen), can also use triptan(frova) for menstrual migraines.
Butterbur(petasites hybridus)(don’t recommend due to hepatotoxicity), Riboflavin(vitamin b12). Could also use feverfew, magnesium, subq histamine.
Can you use botox for migraine prevention?
What is the most common type of primary headaches?
What is your 1st line therapy for tension headaches?
Yes.
Tension headaches.
Simple analgesics +/- caffeine, NSAIDS. Butalbital and codeine combos not recommended. Only use butalbital for 3 days, combo 9 days, NSAIDS 15 days.
What are the most common prophylactic treatment for tension headaches?
What is the most severe primary headache disorder?
What is abortive therapy for cluster headaches?
TCA’s. SSRI’s are not recommended if no depression.
Cluster, affects males more.
Oxygen, Triptans, Ergotamine derivatives(IV DHE results in quickest response).
What are your 3 drugs for prophylaxis for cluster headaches?
How do you treat medication overuse headaches?
How do you treat PBA?
Verapamil, Lithium, Corticosteroids.
discontinue offending agent via taper.
You can use Tricyclic Antidepressants, SSRI’s
What is the only FDA approved PBA treatment?
What is Nuedexta’s side effects?
What drugs is Nuedexta CI’d with?
Nuedexta(dextromorphan/quinidine). Targets glutamate receptors.
Dizziness, Diarrhea, CI’d in people with prolonged QT interval, CI’d in patients with quinidine associated thrombocytopenia, hepatitis, bone marrow suppression.
MAOIs within 14 days, Quinidine related medicines, Pimozide, Thioridazine(drugs that can prolong QT interval).
