Drugs for Headaches - Cohen Flashcards
chronic pain
> 6 months
patient need with HA
want to know explanation for why get HAs
tx of migraine
establish diagnosis
education patient
establish real expectations
migraine criteria
> 5 attacks - 4-72 hours
> 2 of following
- unilateral
- pulsing
- moderate/severe intensity
- aggravated by routine physical activity
> 1 of following
- nausea/vomting
- photophobia/phonophobia
OTC for migraines
sleep, caffeine, dark chocolate, cola
analgesics
anti-inflammatroy
DOC for tx of migraine
triptan - serotonin agonist
stop trigeminal nerve activation
triptans
wirk at 5HT1b, 1d, 1f receptors
no vasoconstriction
CI for triptans
pt with known coronary or cerebral artery disease
ergotamine
multi receptors - 5HT1
-do cause vasoconstriction - can rise BP
IV or IM ergotamine
dihydroergotamine - DHE
for migraines not stopped in first few hours
CGRP receptor
calcitonin gene related peptide receptor
-antagonists shown to be as effective as triptans
preventative drug - mAbs at CGRP
preventative drug for migraine
if patient who can seldom go week without migraine attack
great preventative drug for migraine
amitriptyline, propranolol, topiramate
FDA - propranolol and topiramate
amitriptyline
tricyclic antidepressant
prevent reuptake of serotonin and noradrenaline
very anticholinergic
preventative for migraine
weight gain
with amitriptyline
topiramate
anticonvulsant for epileptics
prevention of migraines
difficulty speech and cognition
anorexia and weight loss
valproic acid
block Na channel and GABA effects
tx of epilepsy and bipolar
side effects of valproic acid
weight gain, thrombocytopenia, tremor, hair loss
botulinum
50% reduction in days of migraine each month
inhibit ACh release
abortive tx cluster HA
triptan
preventative tx cluster HA
verapamil - high dose
lithium - dangerous in suicidal pt
prednisone - mechanism unknown
other tx of cluster HA
DBS and occipital nerve stimulator
tx trigeminal neuralgia
carbamazepine - DOC
also - radiologic or surgical ablation - can be curative
