Headache Flashcards
What is the general mechanisms of analgesics for headache treatment?
COX inhibition (COX2 preferred)
What is the trifecta combination used in analgesic medications to treat headaches?
Acetaminophen, aspirin, caffeine
What two general headache conditions are analgesics used to treat?
Acute moderate migraine and acute tension headaches
A patient has many contraindications for migraine medications but is having an acute migraine. The doctor quickly administers medication. The whiny patient becomes sleepy. What medication did the doctor use? What is an important consideration when using this med?
Barbiturates; Limit the use to 2-3 times per week!
A patient with a history of very few migraines wakes up with an acute migraine. The doctor administers medication. What med was administered? What drugs within this class would be suggested for pregnant women? Maximally, how many times per week would you administer this medication for migraines?
- Opioids
- Codeine or meperidine (with caution)
- 2x/week
A patient chronically using a particular drug for acute migraines develops chronic daily headaches from the drug. What drug was this patient using? What other conditions is this drug used to treat?
Corticosteroids
-Prolonged headache syndromes (chronic daily headache); Rescue treatment for cluster headaches
What are the possible mechanisms of Ergotamines and DHE?
Vasoconstriction and 5HT agonist in trigeminovascular pathway
What are Ergotamine and DHE both used to treat? What are the advantages of DHE over Ergotamine?
Acute treatment of migraine headaches; DHE less likely to cause rebound headache and nausea
What are other therapeutic uses of DHE?
Acute treatment of cluster headaches; short-term prevention of cluster headaches (along with steroids)
What are the overlapping side effects of ergotamine and DHE? What are the contraindications for use?
- Side effects:Nausea (less likely for DHE), dizziness, paresthesia, chest pain, abdominal cramps
- Contraindications: Women planning pregnancy, uncontrolled HTN, sepsis, renal/hepatic failure, vascular disease
I’m a fancy fresh intern in the ED and my patient is having an acute migraine. I have ergotamine in one hand and DHE in the other and I need to inject one of them into my patient, STAT! Which one can I inject?
DHE! BOOM!
What is oxygen used to treat and what can occur when oxygen is stopped?
Acute treatment for cluster headaches; Headache rebound!
My patient tells me that he “can’t poop” and that the room is spinning. What drug did I likely prescribe? To what class does it belong? What is this drug class used to treat?
- Verapamil: Calcium Channel Blocker
- Migraine Prevention, Particularly useful in prolonged/disabling aura, complicated migraine syndromes, long-term prevention of cluster headaches
I want to prevent my patient’s migraines with a Beta Blocker. Which Beta Blockers are FDA approved? Now my patient has asthma! What drugs are now contraindicated? In what other conditions are these drugs contraindicated?
- Propanolol and Timolol
- Asthma: Propanolol, timolol, nadolol, atenolol
- Contracindicated: Diabetes, CHF, Raynaud’s
What do TCAs and SSRIs treat?
Migraine and tension headache prevention
What are the three SSRIs that you need to know about and what are their side effects?
Fluoxetine, paroxetine, sertraline
-Weight gain, sexual dysfunction, headache
What are the unfortunate side effects of beta blockers?
Drowsiness, depression, decreased libido, hypotension, memory disturbances
What are the 3 TCAs and what are their side effects?
Amytriptyline**, protriptyline, nortriptyline
-Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
What in the world would you use Onabotulinum toxin for? How does it work? What are some pesky side effects?
- Migraine Prevention: Unknown mechanism! (possible decreased afferent stim of trigeminovasc system or downreg of sensory and parasymp receptors)
- Side Effects: Injection site pain, headache, neck weakness, ptosis
To what class does Sumatriptan belong?
Triptans!
What is the mechanism of action of Sumatriptan?
Selective 5HT1b-d agonist; penetrates CNS -> constrict extracerebral intracranial vessels -> inhibition of trigeminovascular system
My patient is having an acute migraine! Darn! What would be the “premier” treatment? How would I administer it? What other conditions is this drug used to treat? In what instances would you not use this drug?
- Sumatriptan (also effective for: Photo/phonophobia, N/V, Acute Cluster Headache) -Injection!
- Contraindicated in Vasc Disease, Uncontrolled HTN, complicated migraine
What are the side effects of Sumatriptan?
Flushing, tingling, dizziness, noncardiac chest discomfort
Which two antiepileptic drugs can be used for migraine prevention?
Divalproex sodium ER and Topirimate
