HA

Question 1

• What is Rebound HA?

* 1 of MC chronic headaches*

Answer 1

• A HA that occurs after the use of medication.

Question 2

• When are Triptans use?

* How often should Triptans be used?

Answer 2

• In Men with frequent HA

* Used no more than 10 days / Month

Question 3

• What HA is unilateral, lasts up to 72 hrs, and is associated with N/V and photophobia?

Answer 3

• Migraines

Question 4

T/F: Migraines are associared with complex neural and sensory dysfunction

Answer 4

True

Question 5

• Migraine pain and symptoms are due to _______ and __________

Answer 5

• Neural suppression and Subcortical and Trigenimal activation

Question 6

• Afferent fibers (Peripheral) that innervate the pain-sensitive intracranial blood vessels, dura mater, and venous sinuses are associated with ________ ____

Answer 6

• Migraine Pain

Question 7

______ Pain transmission travels from the meningeal blood vessels to CNS

Answer 7

Nociceptor

Question 8

Activation of _______ sensory nerves triggers the release of ______ _______

Answer 8

• Trigeminal
• Vasoactive neuropeptides
(Calcitonin gene (CGRP), Neurokinin A, substance P)

Question 9

Neuropeptides promote ______ and dural plamsa extravasation, resulting in_____ _______.

Answer 9

• Vasodilation,

* Neurogenic inflammation

Question 10

Sensitization of central sensory neurons produce a ________, that responds to previously ______ stimuli.

Answer 10

• Hyperalgesic

* Innocuous

Question 11

• Vasodilation results in ____ ___ ____ the releases ______ _______ to promote neurogenic inflammation

Answer 11

• Perivascular trigeminal nerves

* Vasoactive neuropeptides

Question 12

T/F: 5-HT mediates migraine HA

Answer 12

True

Question 13

What are the goals of Long-time migraine?

Answer 13

• Reduce Migrain frequency, severity and disability.

Question 14

What are acute OTC Migraine meds?
• Analgesic (2)?
NSAIDs (4)

Answer 14

• Acetaminophen (tylenol), Excedrin

* ASA, Ibuprofen, Naproxen Na, Diclofenac

Question 15

What are the older migraine therapies?

Answer 15

• Ergotamine Tartate

* Dihydroergotaime

Question 16

How do Ergots (non-selective 5-HT) work?

Answer 16

• non-selective 5-HT: Constrict intracranial blood vessel inhibit neurogenic inflammation of trigeminovascular system. Central inhibition of Trigeminovascular receptors

Question 17

• What do selective agonists 5-HT b/d do?

Answer 17

• Inhibition of vasoactive peptide

* Inhibits transmission of 2nd order neurons (ascending thalamus)

Question 18

Sumatriptan
• IV max does = _____
• Orally mixed with ______
• How many sprays with nasal Spray?

Answer 18

• 12mg
• Naproxen
• 1 spray

Question 19

Rizatriptan’s max dose is?

Answer 19

• 5-mg (15 mg/day) if mixed propranolol

Question 20

What do you pretreat before giving Ergotamine Tartrate?

Answer 20

• Antiemetics

Question 21

• Do you tilt you head while spraying Dihydroergotamine?

* When can you discard the ampulses?

Answer 21

Don’t tilt head

• after 8 hours.

Question 22

What to migraine therapies are used in acute relief in the office/ED?

Answer 22

Metoclopramide & Prochlorperazine

Question 23

• What are the sxs of Triptan sensation

Answer 23

• Tightness, pressure, heaviness, pain in the chest, neck, or throat.

Question 24

• What medication treats Migraines and Cluster headaches, and can cause Paresthesia, dizziness, and coronary vasospasm

Answer 24

• Sumatriptan

Question 25

What drug class can cause Serotonin Syndrome?

Answer 25

Benzos = Sedation, paralysis, intubation, and ventilation

Question 26

What drug treats Neuroleptic Malignant syndrome?

Answer 26

• Diphenhydramine - blocks D2, antipsychotic

Question 27

What drug treats Malignant Hyperthermia?

Answer 27

Dantrolene - volatile anesthetic (succinylcholine)

Question 28

• When should you give preventative therapy for migraines?

Answer 28

• when migraine HA are occuring 2+/week

Question 29

• What are the FDA approved Preventative Migraine meds?

Answer 29

``` • Propranolol • Timolol • Divalproex Sodium • Topiramate (Post the damn test - Mcleod) ```

Question 30

• How long should prophylactic Tx be?

Answer 30

6-12 months after diminished HA

Question 31

• What med can decrease Migraine Frequencies in 3-6 months?

Answer 31

CGRP inhibitors - monoclonal antibodies ( -zumabs)

Question 32

• What prophylactic migraine drug is short acting and taken 2/3 x per day

Answer 32

Propanolol

Question 33

• When can Ibuprofen be used for Migraine HA?

Answer 33

Menstrual migraine prevention

Question 34

• What medication is taken in the perimestrual period to prevent menstrual migraines?

Answer 34

Frovatriptan

Question 35

``` What type of HA is this? • Pain behind browbone/cheeks • Pain behind eye • Squeezing band pain • Pain Nausea, photophobia ```

Answer 35

* Sinus * Cluster * Tension * Migraine

Question 36

* what is the most common primary HA? | * what causes this HA?

Answer 36

• Tension HA • From Myofascial and peripheral nociceptor sensitization. * Heightened pain pathway to in CNS

Question 37

• What are the 3 major treatment options for Tension HA?

Answer 37

* CBT * Analgesics (acetaminophen) * NSAIDS (ASA, Diclifenac, Ibuprophen, Naproxen, Ketoprofen, Ketorolac)

Question 38

What are the maximum number of days to take • Butalbital medication • Analgesic Combos • NSAIDS

Answer 38

* 3 days * 9 days (Anagesic = 9 letters) * 15/ Month

Question 39

What meds prevent Tension HA?

Answer 39

* TCAs * SSRIs * SNRIs (only Mitrazapine and Venlafaxine) * Topiramate * Gabapentin * Botulism

Question 40

What HA type causes excruciating, unilateral pain that lasts for months?

Answer 40

• Cluster

Question 41

* What part of the brain modulates Cluster HA? | * What is the Hallmark of Cluster Headaches (rhythms)?

Answer 41

* Ispilateral hypothalamic grey area | * Circadian rhythm

Question 42

T/F: The Midbrain secondarily activates trigenimal-autonomic reflexes?

Answer 42

False | • the Hypothalamus secondarily activates.

Question 43

• What headache benefits from sitting in a quiet, dark room?

Answer 43

• Migraines, | * Cluster patients rock or pace clutching their head*

Question 44

* What headache is treated with 100% Oxygen at 12 L/Min for 30 mins? * Also treated with spray triptans or oral zolmitriptan?

Answer 44

Cluster HA

Question 45

* What is 1st Line Cluster HA treatment? * Why give a patient Lithium? * Can I give corticosteroids?

Answer 45

* Verapamil (1st line) * Lithium in patients with thyroid and renal function. * Yes - Prednisome