Drugs for Headaches Flashcards
Classic Migraine has 2 of these 4 characteristics
1) One or more fully reversible aura symptoms
2) At least one aura symptom for more than 4 minutes
3) 2 or more symptoms occurring in succession
4) Headache follows aura within 60 minutes
Migraine w/o aura has 2/5 of the following
1) Unilateral location
2) Pulsating quality
3) Intensity moderate or severe
4) Aggravation by walking stairs (or other normal routine activity)
5) Nausea &/or vomiting; photophobia; phonophobia
Tension HA last for how long?
30 minutes to 7 days
Tension HA have 2/4 characteristics
1) pressing
2) Mild to moderate
3) bi lateral
4) Physical activity does not agrevate it
Cluster HA
short lived but searing/burning pain lasting 15 min-3 hours
Cluster HA has one of the following symptoms
Lacrimation Nasal congestion Rhinorrhea Facial sweating Miosis Eyelid edema
Analgesic HA
pts use too many analgesics- more than 3x/week
What are the two phases of a migraine?
1) Phase 1- vasoconstriction, CNS releases serotonin, platelets release serotonin
2) Phase 2- Trigeminal nerve release substance P- vasodilation
How long should pts try a certain migraine prophylaxis?
at least 3-4 weeks is an adequate trial
how do migraine prohylaxis med work?
prevent vasoconstrictive phase
What are 6 Rx for migraine prophylaxis
1) Amitriptyline (Elavil)-TCA
2) Propranolol (Inderall)-BB
3) Nadolol-BB
4) Valproic acid (Depakote)-mood stabilizer for bi polar and anti convulsant
5) Topiramate (Topamax)
6) Botulinum toxin (Botox) – prophylaxis of chronic migraine (>14 days/month)
What are 7 acute treatments/med groups for migraines?
Triptans Ergots NSAIDS Opioids Isometheptene (Midrid) Corticosteroids antiemetics
Triptans
-triptan
MOA of triptans
5HT 1D/1B receptor agonists (5HT=serotonin)
cause vasoconstriction of cerebral vessels to relieve HA
Who are triptans contraindicated for?
ppl w/ risk of coronary artery disease, stroke, hypertension, peripheral vascular dz
What are adverse effects of triptans?
altered sensation- warmth
dizziness
neck pain
chest pain
Triptan drug interaction
- wait 2 weeks after taking MAOI
- do not use within 24 hrs of ergotamines
- careful of serotonin syndrome
Ergots
-ergotamine
Cafergot
caffine + ergotamine
What does caffine doe to ergotamine?
Increases absorption
MOA of Ergots
- Agonist, partial agonist & antagonist @ alpha adrenergic & serotonin receptors
- Agonist or partial agonist @ CNS dopamine receptors
- inhibits vasodilating peptides and is a direct vasoconstrictor
Ergot effects on smooth muscle
- causes prolonged vasospasm which can lead to long vasoconstriction and gangrene
- constrictive effects are not reversible
Ergot effect on uterus
-stimulates contraction especially if pregnannt but they are not like labor contractions
Are ergots useful in migraines?
They are not recomended for migraines but they are used iif triptans are not helpful.
