Headache Flashcards
Name the four phases of migraine.
Prodrome, aura, headache, resolution
What is activated in the headache phase of migraines?
Trigeminovascular system
What do the trigeminal nerve fibers release during a headache and what does it result in?
Release of vasodilators and permeability promoting peptides–> this causes sterile inflammation–> hyperalgesia to previously innocuous stimuli
MOA of sumatriptan?
selective 5HT1b/D agonists, causes constriction of intracranial extracerebral bv, alleviating pain
Name two categories of medications used for acute migraine treatment?
Nonspecific medications- “pain meds”
Specific medications
Name two specific medications used for the treatment of acute migraine.
Ergotamines/DHE and triptans
When are nonspecific medications indicated in migraine treatment?
mild to moderate intensity Special populations (pregnant women, children, cardiovascular risk)
When is it okay to use barbiturates to treat migraine?
Pt uses less than 2-3x/wk
when other treatments are unavailable/ contraindicated
In regards to headaches, when would you treat with analgesics?
Acute migraine, acute tension headache
When is corticosteroid use indicated for treatment of headache?
Mainly prolonged headache syndromes
acute migraine, cluster headache also
When are opioids indicated for treatment of headache?
Pts that wake up with headache, infrequent
acute treatment
MOA of ergotamine and DHE?
vasoconstriction and 5HT agonist in trigeminovascular pathway
SE of ergotamine/ DHE?
nausea, dizziness, paresthesia, chest pain, abdominal cramps
What are contraindications of ergotamine/DHE use?
women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease
SE of triptans?
flushing, tingling, dizziness, chest discomfort
Use of sumatriptan?
acute migraine, effective for photophobia, N/V, acute cluster treatment
Name three “classes” of drugs used for prevention of migraines.
Anti-epileptics
Anti-hypertensives
Anti-depressants
Name two anti-depressants used in migraine and tension headache prevention.
TCA and SSRI
SE of TCA?
dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
SE of SSRI?
weight gain, sexual dysfunction, headache
SE of Beta-blockers?
drowsiness, depression, decreased libido, hypotension, memory disturbance
Name two B-blockers used for the treatment of migraine.
Propanolol and timolol
contraindication for B-blocker in treatment of migraine?
asthma, diabetes, CHF, raynauds
When are Ca channel blockers used for treatment of headahce?
Pts w/ prolonged aura
Migraine and cluster headache prevention
SE of Calcium channel blockers?
constipation, dizziness
Treatment of choice in long term prevention of cluster headaches?
Verapamil (Ca channel blocker)
other options…
Topiramate, Valproic Acid (Antiepileptics)
Lithium
