Headache

Question 1

Name the four phases of migraine.

Answer 1

Prodrome, aura, headache, resolution

Question 2

What is activated in the headache phase of migraines?

Answer 2

Trigeminovascular system

Question 3

What do the trigeminal nerve fibers release during a headache and what does it result in?

Answer 3

Release of vasodilators and permeability promoting peptides–> this causes sterile inflammation–> hyperalgesia to previously innocuous stimuli

Question 4

MOA of sumatriptan?

Answer 4

selective 5HT1b/D agonists, causes constriction of intracranial extracerebral bv, alleviating pain

Question 5

Name two categories of medications used for acute migraine treatment?

Answer 5

Nonspecific medications- “pain meds”

Specific medications

Question 6

Name two specific medications used for the treatment of acute migraine.

Answer 6

Ergotamines/DHE and triptans

Question 7

When are nonspecific medications indicated in migraine treatment?

Answer 7

mild to moderate intensity
Special populations (pregnant women, children, cardiovascular risk)

Question 8

When is it okay to use barbiturates to treat migraine?

Answer 8

Pt uses less than 2-3x/wk

when other treatments are unavailable/ contraindicated

Question 9

In regards to headaches, when would you treat with analgesics?

Answer 9

Acute migraine, acute tension headache

Question 10

When is corticosteroid use indicated for treatment of headache?

Answer 10

Mainly prolonged headache syndromes

acute migraine, cluster headache also

Question 11

When are opioids indicated for treatment of headache?

Answer 11

Pts that wake up with headache, infrequent

acute treatment

Question 12

MOA of ergotamine and DHE?

Answer 12

vasoconstriction and 5HT agonist in trigeminovascular pathway

Question 13

SE of ergotamine/ DHE?

Answer 13

nausea, dizziness, paresthesia, chest pain, abdominal cramps

Question 14

What are contraindications of ergotamine/DHE use?

Answer 14

women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease

Question 15

SE of triptans?

Answer 15

flushing, tingling, dizziness, chest discomfort

Question 16

Use of sumatriptan?

Answer 16

acute migraine, effective for photophobia, N/V, acute cluster treatment

Question 17

Name three “classes” of drugs used for prevention of migraines.

Answer 17

Anti-epileptics
Anti-hypertensives
Anti-depressants

Question 18

Name two anti-depressants used in migraine and tension headache prevention.

Answer 18

TCA and SSRI

Question 19

SE of TCA?

Answer 19

dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension

Question 20

SE of SSRI?

Answer 20

weight gain, sexual dysfunction, headache

Question 21

SE of Beta-blockers?

Answer 21

drowsiness, depression, decreased libido, hypotension, memory disturbance

Question 22

Name two B-blockers used for the treatment of migraine.

Answer 22

Propanolol and timolol

Question 23

contraindication for B-blocker in treatment of migraine?

Answer 23

asthma, diabetes, CHF, raynauds

Question 24

When are Ca channel blockers used for treatment of headahce?

Answer 24

Pts w/ prolonged aura

Migraine and cluster headache prevention

Question 25

SE of Calcium channel blockers?

Answer 25

constipation, dizziness

Question 26

Treatment of choice in long term prevention of cluster headaches?

Answer 26

Verapamil (Ca channel blocker)

other options…
Topiramate, Valproic Acid (Antiepileptics)
Lithium