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Pharm-Neuro > Drugs for Headaches > Flashcards

Drugs for Headaches Flashcards

1
Q

Classic Migraine has 2 of these 4 characteristics

A

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

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2
Q

Migraine w/o aura has 2/5 of the following

A

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

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3
Q

Tension HA last for how long?

A

30 minutes to 7 days

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4
Q

Tension HA have 2/4 characteristics

A

1) pressing
2) Mild to moderate
3) bi lateral
4) Physical activity does not agrevate it

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5
Q

Cluster HA

A

short lived but searing/burning pain lasting 15 min-3 hours

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6
Q

Cluster HA has one of the following symptoms

A 
Lacrimation
Nasal congestion
Rhinorrhea
Facial sweating
Miosis
Eyelid edema
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7
Q

Analgesic HA

A

pts use too many analgesics- more than 3x/week

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8
Q

What are the two phases of a migraine?

A

1) Phase 1- vasoconstriction, CNS releases serotonin, platelets release serotonin
2) Phase 2- Trigeminal nerve release substance P- vasodilation

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9
Q

How long should pts try a certain migraine prophylaxis?

A

at least 3-4 weeks is an adequate trial

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10
Q

how do migraine prohylaxis med work?

A

prevent vasoconstrictive phase

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11
Q

What are 6 Rx for migraine prophylaxis

A

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)

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12
Q

What are 7 acute treatments/med groups for migraines?

A 
Triptans
Ergots
NSAIDS
Opioids
Isometheptene (Midrid)
Corticosteroids
antiemetics
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13
Q

Triptans

A

-triptan

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14
Q

MOA of triptans

A

5HT 1D/1B receptor agonists (5HT=serotonin)

cause vasoconstriction of cerebral vessels to relieve HA

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15
Q

Who are triptans contraindicated for?

A

ppl w/ risk of coronary artery disease, stroke, hypertension, peripheral vascular dz

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16
Q

What are adverse effects of triptans?

A

altered sensation- warmth
dizziness
neck pain
chest pain

17
Q

Triptan drug interaction

A
  • wait 2 weeks after taking MAOI
  • do not use within 24 hrs of ergotamines
  • careful of serotonin syndrome
18
Q

Ergots

A

-ergotamine

19
Q

Cafergot

A

caffine + ergotamine

20
Q

What does caffine doe to ergotamine?

A

Increases absorption

21
Q

MOA of Ergots

A
  • Agonist, partial agonist & antagonist @ alpha adrenergic & serotonin receptors
  • Agonist or partial agonist @ CNS dopamine receptors
  • inhibits vasodilating peptides and is a direct vasoconstrictor
22
Q

Ergot effects on smooth muscle

A
  • causes prolonged vasospasm which can lead to long vasoconstriction and gangrene
  • constrictive effects are not reversible
23
Q

Ergot effect on uterus

A

-stimulates contraction especially if pregnannt but they are not like labor contractions

24
Q

Are ergots useful in migraines?

A

They are not recomended for migraines but they are used iif triptans are not helpful.

25
Q

How can ergots be used in OBGYN?

A

Thye can be used to stop post-partum hemorrage bleeding

26
Q

NSAIDS and migraines

A

acetominophen does not work alone, must be in combination with aspirin and caffine

27
Q

What opiate is used in migraines?

A

Butorphanol (stadol)
it is super addictive
do not use more than twice a week
only used when other meds are innefective

28
Q

Corticosteroids and migraines

A

Rescue med for status migranous which is a migraine that lasts for a long time

29
Q

What the two antiemetics most commonly used in treating migraine that cause drowsiness?

A

Domperidone

metoclopramide

30
Q

What are two antiemetics used in treating migraines that are sedating?

A

Prochlorperazine

chlorpomazine

31
Q

Zofran

A

antiemetic, does not cause dowsiness, effective for migraines

32
Q

Tension HA prophylaxis. 3 drugs

A

TCAs (amitriptyline)
Mirtazepine (Remeron)
Venlafaxine (Effexor)

33
Q

Tension HA treatment 3

A

Acetaminophen
NSAIDS
COMBO

34
Q

Cluster HA Prophylaxis

A 
Verapamil
Ergotamine
prednisone and Dexamethasone
lithium
topiramate
35
Q

Treatment of cluster HAs

A

triptans
O2
intranasal lidocaine
ergotamine

36
Q

Dijydrogotamine

A

IV delivered

Pharm-Neuro (6 decks)

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