Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MS/HA/Stoke/Sleep > HA > Flashcards

HA Flashcards

1
Q

Migraine phases

A

Premonitory, HA pain phase, and postdrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Premonitory phase

A

-tiredness, mood change, cravings, light/sound sensitivity
-hrs to days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HA pain phase

A

-throbbing, N/V, sensitivity to senses
-4 to 72 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Postdrome phase

A

-tired, hard to concentrate
-up to 48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Auras

A

-can occur w/o HA
-last minutes, unilateral, fully reversible visual sensory or other CNS sx that usually develop gradually
-visual&raquo_space; sensory > language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Migraines

A

positive visual sx, gradual onset/evolution, sequential progression, repetitive attacks, flurry of attacks midlife, duration < 60 min, HA follows (50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How TIAs are different than Migraines

A

visual loss, abrupt, simultaneous occurrence, <15 min, HA doesn’t usually follow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mild to moderate migraine attack treatment

A

NSAIDs, APAP, caffeinated analgesic combos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Moderate to severe migraine attack treatment

A

Triptans, DHE, Gepants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Refractory moderate to severe treatment

A

Combo triptan and NSAIDs, Gepants, Ditans, combo of analgesics w/ codeine or tramadol, opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diclofenac Potassium

A

-oral NSAID soln
-can only be added to water bc pH sensitivity
-rapid absorption and shorter time to peak w/ the soln
-used for ACUTE treatment >/= 18 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Celecoxib

A

-oral NSAID soln
-used for ACUTE treatment in adults
-can be used in combo with Triptans for more severe cases
-If an NSAID works for a patient but takes too long to kick in use oral soln formulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Butalbital/APAP/Caffeine (Fioricet)

A

-butalbital is a barbiturate which can be abused
-reserve for last resort , not preferred for migraine
-BBW: hepatotoxicity (APAP)
-available w codeine (CIII)
*medication overuse HA can occur w this med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Triptans

A

-generally 1st line
-used for ACUTE treatment
-limit to < 10 days per month (MOH)
-may combine w NSAIDs (Treximent = Suma/naproxen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Triptan CI

A

hemiplegic migraine or migraine w brainstem aura, heart disease, wolff-parkinson-white syndrome or arrhythmias, STROKE, TIA, peripheral vascular disease, use within 24 hrs of ergotamine or different triptan, MAOIs (w/ sum, riz, zol only) -SS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Almotriptan

A

-better tolerated than suma
-sulfa group
-dose reduction for 3A4 inhibitors
-CrCl </= 30 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Eletriptan

A

-Cl w potent 3A4 inhibitors
-not rec in severe hepatic disease
-mostly lipophilic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Frovatriptan

A

longest half life, slow onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Naratriptan

A

slow onset, second longest half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rizatriptan

A

dose reduction w/ propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sumatriptan

A

lowest oral bioavailability
-PO, intranasal spray, powder, SQ
-SQ is the fastest onset
-Spray is the second fastest onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Zolmitriptan

A

-reduction or d/c in hepatic disease
-PO, ODT, spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lasmiditan

A

-CV
-used for ACUTE treatment in adults
-must wait at least 8 hours b/t dosing and operating heavy machinery or driving
-AE: CNS depression, SS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gepants

A

-small molecule CGRP receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Rimegepant (Nurtec)
-Gepant -PO, ODT -used for ACUTE and PREVENTATIVE
26
Ubrogepant (Ubrelvy)
-PO -used for ACUTE treatment -may repeat dose after >/= 2 hours -admin w high fat meals delays Tmax by 2 hrs and reduces Cmax by 22%
27
Anti-Migraine Ergots
-not used first bc lots of SE/CI -BBW: CI w potent 3A4 inhibitors including protease inhibitors, macrolide abx and azole fungals -AE: cardiac valvular fibrosis, ergotism -don't use in preg/lac -do not use within 24 hrs of triptans or serotonin agonists or ergot containing or like agents
28
Ergotamine
-Ergot -used for ACUTE treatment -considered when migraine lasts for more than 48 hrs or pt has freq HA reoccurrence -SL tab (available combo w caffeine) -d/c can result in withdrawal like rebound HA (can occur when doses exceed 10 tab per week) -grapefruit juice inc ergot levels -may worsen N/V associated with migraine
29
Dihydroergotamine (DHE)
-Ergot -Injection: ACUTE treatment of cluster HA -Injection/Nasal spray: ACUTE treatment of migraines -Off label: MOH, status migrainosus -fewer SE than Ergotamine -Intranasal has cafeine -don't use within 24 hrs of triptans or another ergot agent -first does = at a facility (get ECG for pts with CAD risk) -CI: hemiplegic migraine and migrane w brainstem aura
30
CGRP monoclonal antibodies
-use caution in CV or cerebrovascular ischemic events -Few DDI: Efgartigimod -Drugs: Ajovy, Vyepti, Aimovig, Emgality
31
Vyepti
-CGRP ligand -IV every 3 months -Infusion rxn, nasopharyngitis, nausea
32
Aimovig
-CGRP receptor -SQ every month -Injection site rxn, constipation
33
Ajovy
-CGRP ligand -SQ every month or every 3 months -injection site rxn
34
Emgality
-CGRP ligand -can also be used to prevent cluster HA -SQ every month -injection site rxn
35
Peripheral nerve blocks
-Greater occipital nerve block (lidocaine &/or bupivacaine &/ or methylprednisolone -can't use methylprednisolone in pregnacy
36
Non pharm
-stress reduction, dietary changes, trigger avoidance, Mg2+, vitamin B2 (riboflavin), feverfew, butterbar, neuromodulator devices
37
FDA approved neuromodulator devices
-electroCore: ACUTE/PREVENTATIVE -eNeura: ACUTE/PREVENTATIVE -CEFALY: ACUTE/PREVENTATIVE -Neurolief: ACUTE -Nerivio: ACUTE
38
PO Mg2+
-good for menstrual migraine -AE: diarrhea (titrate slowly) -improve platelet function -prevent narrowing of brain blood vessels
39
B2 (riboflavin)
-good for menstruating women
40
Feverfew
Avoid use in preg (uterine concentrations/abortions can occur)
41
Butterbar
avoid products not labeled as free from pyrrolizidine alkaloids (PA-free)
42
Botox
-for chronic migraine sufferers -BBW: spread of toxin effect -admin every 12 weeks -AE: ISP, neck pain, myalgia, facial paresis -Adequate trial = 3 full treatments -total dose = 155 units -each dose should be divided and admin bilaterally into 31 total sites
43
Menstral migraines
-Frovatriptan -Naratriptan -Estrogen contraceptives (avoid in aura patients bc inc stroke risk)
44
Special population
-CVD patients: Gepants or lasmiditan -pregnancy: APAP 1st line - migraines improve during preg (avoid NSAIDs in 3rd trimester) -lactation: less likely to have migraines if pt breastfeeds
45
Tension HA
-30 to 7 days -bilateral, non pulsating, no N/V, either photophobia or phonophobia -Acute treatment: NSAIDs/APAP, analgesics w caffeine, combo w butalbital or codeine -Preventative: AD (TCAs, Mirtazapine, Venlafaxine), AED (Gabapentin, topramax, trigger point injection)
46
Cluster HA
-pain on one side -5 attacks -acute: O2, sq (preferred) or nasal suma or nasal zolmitriptan -preventative: verapamil, glucocorticoids
47
Hemicrainia continua
-responses to indomethacin -alternatives: nerve block, vagus nerve stimulation, etc -unilateral -conjunctival, nasal, eyelid, forehead SE
48
TBI HA
-similar features of migraine &/or tension HA -HA occurs w/i 7 days of head trauma
49
Pseudotumor cerebri
-papilledema (swelling of optic disc) -med induced (growth hormone, tetracyclines, retinoids -withdrawal agent, weight loss, carbonic anhydrase inhibitor (topamax, acetazolamide), furosemide
50
brain tumor HA
-like tension type HA -bilateral or on side of tumor -sx: seizures, cognitive dysfunction, focal weakness
51
Reversible cerebral vasoconstriction syndrome
-thunderclap HA -meds assoc: SSRIs, triptans, ergots, cyclophosphamide, tacrolimus, nasal decongestant, illegal drugs
52
subarachnoid HA
-life threatening -sudden or thunderclap onset of HA -photophobia, neck stiff, brief loss of consciousness -worst HA of my life
53
sub withdrawal HA
-caffeine -opioid -estrogen, TCAs, SSRIs
54
HA red flags
-systemic s/s -systemic disease -neurologic s/s -onset sudden (thunderclap) -onset after 40 yo -pattern change
55
MOH
-inc excitability of neurons -Ergots: >/= 10 days/month -Trips: >/= 10 days/month -opioids: >/= 10 days/month -non opioid analgesics: >/= 15 days/month -butalbital: >/= 5 days/month -treatment: dec or ween off med, initiate prophylaxis w/ prn breakthrough therapy
56
Topiramate
-Preventative treatment -Off label: prevention of cluster HA -AE: cognitive dysfunction, CNS effects, suicidality, wt loss -Important to stay hydrated -Avoid in Preg
57
VPA
-Preventative treatment -BBW: hepatotoxicity, mitochondrial disease, fetal risk, pancreatitis -AE: TEN, SJS, DRESS, suicidality -CI: prevention in preg or women not using contraception
58
Beta blockers
-Metoprolol, propranolol, timolol, atenolol, nadolol -indicated for migraine prevention: propranolol, timolol
59
TCAs
-Amitriptyline, Nortriptyline -BBW: suicidality -AE: anticholinergic, cardiac conduction abnormalities
60
Venlafaxine
-BBW: suicidality
61
Atogepant
-gepant -used after previous meds bc of cost

MS/HA/Stoke/Sleep (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions