Headache Flashcards
Migraine vs Tension Headache
Tension Type Headache Treatments
(Abortive vs preventative)
Abortive: NSAIDs, ASA, Tylenol, OTC combo with caffeine
Preventative: TCAs, Muscle relaxers, SSRI (venlafaxine)
TCA Mechanism of Action and Examples
Amitriptyline, nortriptyline
Inhibit reuptake of serotonin and noradrenaline
Inhibit norepinephrine reuptake
NMDA receptor antagonist
TCA Adverse Effects and Black Box Warning
Sedation, QT prolongation, blood pressure changes, anticholinergic effects.
Black box warning: make increase SI
Migraine Abortive Therapy
1st line: NSAID, combo OTC w/caffeine, Tylenol, anti-emetics
2nd line: Triptans, ergotamines, Lasmiditan, CGRP antagonists
Triptan MOA
Activates 5-HT I B/ID receptors to mediate vasoconstriction; blocks trigeminal nerve transmission and constricts dilated blood vessels
Triptans Adverse Effects
Chest pressure/tightnes, malaise, fatigue, dizziness, vertigo, sedation, n/v
*Triptans are considered safe to take with SSRI, low risk for serotonin syndrome
Serotonin syndrome
Ergots examples and mechanism of action
Dihydroergotamine, Ergotamine
MOA: Acts on serotonergic, dopaminergic and alpha-adrenergic receptors, which constrict peripheral & cranial blood vessels
Ergots Contraindications and adverse effects
Contraindication: Cardiac conditions
Adverse effects: n/v, flushing, dyspnea, HTN
Lasmiditan mechanism of action
Selective serotonin (5-HT)1F receptor agonist that lacks vasoconstrictor activity.
Lasmiditan contraindications and adverse effects
Contraindicated with liver disease
AE: dizziness, paresthesia, drowsiness, may cause hypertension & bradycardia
CGRP examples and mechanism of action
Erenumab (Aimovig), Fremanezumab (Ajovy), Galcanezumab (Emgality), Eptinezumab (Vyepti), Rimegepant (Nurtec)
Monoclonal antibodies against calcitonin gene-related peptide (CGRP) receptor or directly against CGRP
CGPR antagonist adverse effects
Constipation, HTN, hypersensitivity, injection site reaction
No contraindications
