Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Competency > HA & Migraine > Flashcards

HA & Migraine Flashcards

1
Q

What are the 3 types of headaches?

A
  • tension-type HA
  • migraine
  • cluster HA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the features of TTH based on:
- pain location
- pain characteristics
- pain intensity
- effect on activities
- other sx
- duration

A
  • pain location: bilateral
  • pain characteristics: pressing / tightening
  • pain intensity: mild-moderate
  • effect on activities: not aggravated by routine activities of daily living
  • other sx: none
  • duration: 30min-7D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the features of migraine based on:
- pain location
- pain characteristics
- pain intensity
- effect on activities
- other sx
- duration

A
  • pain location: unilateral / bilateral
  • pain characteristics: pulsating / throbbing
  • pain intensity: moderate-severe
  • effect on activities: aggravated by / causes avoidance of routine activities of daily living
  • other sx: N/V, photophobia, phonophobia, aura
  • duration: 4-72h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of cluster HA based on:
- pain location
- pain characteristics
- pain intensity
- effect on activities
- other sx
- duration

A
  • pain location: unilateral (around eye/along face)
  • pain characteristics: variable
  • pain intensity: severe to very severe
  • effect on activities: restlessness / agitation
  • other sx: cranial autonomic sx in the same side as HA (red, water, swollen eye, nasal congestion, runny nose, sweating)
  • duration: 15-180min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Red flags for HA?

A

SNNOOP10
- systemic sx including fever
- neoplasm
- neurologic deficit / dysfunction
- onset is sudden
- older age >50y
- pattern change / recent onset of HA
- positional HA
- progressive HA with atypical presentation
- precipitated by sneezing, coughing or exercise
- papilledema
- painful eye with autonomic features
- pregnancy / puerperium
- post-traumatic onset of HA
- pathology of immune system (e.g. HIV, immunocompromised)
- painkiller overuse / new drug at onset of HA

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

Classification of TTH?

A
  • infrequent episodic: 30min-7D (<1 episode/m, at least 10 HA episodes but <12D/y)
  • frequent episodic: 30min-7D (1-14D/m, at least 10 HA episodes for >3m, ≥12D but <180D/y)
  • chronic: hours to days or unremitting (≥15D/m, for 3m, ≥180D/y)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Phases of migraine? How long does each phase occur?

A
  • prodrome: a few hours to days (≤48h)
  • aura: 5-60min
  • HA: 4-72h
  • postdrome: ≤48h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Triggers of TTH? (7)

A
  • physical / emotional stress
  • activities that cause the head to be held in one position for a long time
  • alcohol (binge then withdraw)
  • caffeine (withdrawal sx)
  • cold / flu / sinus infx
  • dehydration
  • hunger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute tx of TTH?

A
  • paracetamol (alone or with caffeine), aspirin
  • NSAIDs (ibuprofen, naproxen, diclofenac, ketoprofen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Prophylactic tx for TTH?

A

1st line: amitriptyline, nortriptyline
2nd line: mirtazapine, venlafaxine

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

Non-pharm for TTH?

A
  • HA diary
  • CBT, biofeedback, relaxation, stress management
  • PT/OT
  • lifestyle (sleep hygiene, proper posture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is considered medication overuse HA?

A
  • HA on ≥15D/m
  • regular overuse of acute +/ symptomatic HA drugs for >3m
    –> paracetamol / aspirin / NSAIDs on ≥15D/m
    –> ergotamines / opioids / triptans on ≥10D/m
    –> combi of analgesics on ≥10D/m
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classification of migraine by frequency?

A
  • episodic: ≥5 migraine attacks lasting 4-72h in a lifetime
  • chronic: >3m with ≥15 HA days, including ≥8 MMD

MMD: monthly migraine day: ≥2 migraine characteristics, or with photophobia/phonophobia/N/V during HA if no aura

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

What are some aura sx for migraine?

A
  • visual (zigzag lines, rainbow)
  • sensory or speech disturbance
  • motor sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute tx for migraine?

A

1st line
- paracetamol
- NSAIDs (ibuprofen, naproxen, diclofenac, ketoprofen)
- aspirin

2nd line
- triptans (e.g. sumatriptan, zolmitriptan, eletriptan) if not relieved by OTC analgesics

3rd line
- triptans + naproxen sodium

Others
- ergotamine + caffeine
- opioids
- ditans & gepants (not in SG) e.g. erenumab (CGRP receptor antagonist)

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

Triptans MOA?

A

5HT1B and 5HT1D receptor agonist -> decrease trigeminal neuron activity -> vasoconstriction of cerebral blood vessels + inhibit vasoactive peptide release by trigeminal neuron -> inhibit nociception

17
Q

CI of ergotamine + caffeine?

A
  • CVD, CHD, uncontrolled HTN
  • cerebrovascular disease
18
Q

CI of triptans?

A
  • CHD, arterial HTN
  • MI, ischaemic stroke
  • Raynaud’s disease
  • pregnancy & lactation
  • concurrent adm with serotonergic agents
19
Q

Does migraine occur with or without aura?

A

Can occur with or without aura

20
Q

What triggers migraine attacks?

A
  • hormones (menstrual cycle, ovulation)
  • diet (alcohol, caffeine)
  • behaviour (irregular meal times, lack sleep, stress, too much exercise)
  • env (bright/flashing lights, loud noise, strong odour)
  • meds (COC, HRT, nitroglycerin, histamine)
21
Q

Nonpharm for migraine?

A
  • relaxation, CBT
  • acupuncture
  • eliminate triggers
22
Q

What can be used for N/V a/w migraine?

A

Anti-emetics: metoclopramide, domperidone

23
Q

If response to sumatriptan is inadequate, what else can be added for therapy?

A

Naproxen sodium (3rd line of acute tx)

24
Q

When can preventive tx be considered for migraines?

A
  • ≥4 migraine days per month
  • attacks have a substantial impact on their lives despite appropriate use of acute meds
  • frequency of migraine attacks puts them at risk of medication overuse HA
25
Q

How long should preventive tx be tried for one drug before saying it is ineffective?

A

≥ 2 months

26
Q

What outcome shows that preventive med is effective for migraine?

A

Migraine attack frequency or number of HA days/month reduced by ≥50%

27
Q

When should drug be weaned off for preventive tx?

A

After 6-12m of successful preventive tx

28
Q

Preventive tx options for migraine?

A

1st line
- BB (propranolol, metoprolol, atenolol)
- antidepressants (amitriptyline, nortriptyline)

2nd line
- ARB (candesartan)
- ASM (topiramate)

3rd line
- CGRP monoclonal antibodies (erenumab) if all else fails

Others
- ASM (sodium valproate)
- botox
- CCB (flunarizine)

Competency (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions