Drugs for Headaches Lecture PDF

Question 1

Principles of migraine headache treatment (2)

Answer 1

• Management at abortive or symptomatic therapy of onset attack
• prevention of attack all together

Question 2

Drug of choice in mild migraine, moderate, and severe

Answer 2

• nonopiod analgesic (NSAIDs, excedrin migraine (ibuprofen+caffeine)
• triptans
• opioid

Question 3

Excedrin migraine content, clinical usefulness

Answer 3

• Acetaminophen, aspirin, caffeine

- readily effective in studies

Question 4

Theories to how NSAIDs alleviate migraine pain (3)

Answer 4

• inhibition of PG synthesis
• blocking platelet aggregation
• reducing serotonin release

Question 5

Indomethacin

Answer 5

AVOID it regarding migraine treatment because it causes headaches

Question 6

Injectable ketorolac function

Answer 6

highly useful in resolving nausea and vomiting in migraine patients

Question 7

Serotonin 1B/1D receptor agonists (triptans) function, mech of action, ADR’s (3), drug interactions

Answer 7

• Allow for relief generally 60 minutes after administration
• analogue of serotonin that stimulates receptor subtypes causing vasoconstriciton of intracranial blood vessels
• Chest pain, coronary vasospasm (contraindicated in CAD patients), vertigo
• MAOI’s increase half life, SSRI’s can lead to serotonin syndrome

Question 8

Ergotamine function, mech of action, ADR’s (2)

Answer 8

• Used to stop an ongoing migraine attack and to treat cluster headaches not to be used on a long term basis (especially not daily)
• Direct vasoconstrictor of smooth muscle in cranial blood vessels and an agonist at serotonin receptors
• Ergotism (headache, NVD, gangrene of fingers and toes), Ischemia resulting in cold limbs and potential gangrene

Question 9

dihydrogotamine function, contraindications (2)

Answer 9

• Nonsedating serotonin agonist used as DOC for terminating severe refracatory migraine and cluster headaches and provides minimal peripheral vasoconstriction and little physical dependence (unlike ergotamine)
• CAD, peripheral vascular disease

Question 10

butorphanol nasal spray function, administration, ADR’s (2)

Answer 10

• An opioid agonist-antagonist nasal spray effective for relief of moderate to severe migraine
• One spray in one nostril, another in the other following 60 min, same 2 dose sequence repeated next 3-5 min
• Syncope, respiratory depression

Question 11

Butterbur

Answer 11

Extract supplement given prophylactically in migraine patients that has been shown to have a 50% reduction or greater in headaches, can cause mild GI upset as common side effect