Headache Flashcards
What is a primary headache?
Migraine, TTH, Trigeminal automnomic cephalagias, and other primary HA disorders
What is a secondary headache?
Headache with secondary causes -
Trauma or injury to head or neck
Cranial or cervical vascular disorder
Non-vascular intracranial disorder
Infection
Homeostasis disorder
Psychiatric disorder
Tension-type headache
Bilateral pressing/tightening of the head, mild to moderate pain and not aggravated by routine ADL.
Usually lasts for 30 minutes to 7 days
Triggers: Alcohol, caffeine, cold/flu, dehydration, hunger, emotional/physical stress, holding head in one position for too long
Pharmacological agents for TTH
Acutely - paracetamol (+/- caffeine), aspirin, ibuprofen, naproxen, diclofenac, ketoprofen
Pharmacological (prophylactic) - amitriptyline, mirtazapine, venlafaxine
non-pharm: sleep hygiene, alcohol/caffeine reduction, CBT, relaxation
Diagnostic red flags for headache-related symptoms
Fever, weight loss, night sweats, rash
Recent history of trauma or injury
Change in mental status or function
Onset of headache is sudden or abrupt
Pattern change or recent onset of headache
Positional headache
Precipitated by sneezing, coughing or exercise
Increased ICP (headache, vomitting, papilledema, altered mental status)
Tingling, numbness or loss of sensation, photophobia, photophonia, difficulty walking or speaking
Stroke symptoms (weakness on one side, drooping of nasalabial folds)
Migraine
Unilateral or bilateral, pulsating, can be moderate to severe pain
Aggravated by ADL
Accompanied with nausea/vomiting, photo/phono sensitivity, visual, sensory or speech disturbance.
If associated with dizziness, rule out vestibular migraine
Can last for 4 to 72 hours
Cluster headache
Unilateral and along the eye or face, severe pain, agitated
Can also have swollen eye, nasal congestion, sweating.
Briefly describe premonitory, aura, headache, postdrome and interictal
Premonitory - fatigue, mood changes, cravings, cognitive difficulties, yawning
Aura - visual sensory, speech disturbance, motor symptoms
Headache - photo/phonophobia, nausea +/- vomitting, headache
Postdrome - difficulty concentrating, tired, neck stiffness
Pharmacological agents for acute treatment of migraine
Triptans, ergootamine derivatives, gepants, lasmiditan
NSAIDS: aspirin, celecoxib, diclofenac, ibuprofen, naproxen
Acetaminophen + caffeine + aspirin
Probable: anti-emetics: metoclopramide, chlorpromazine, prmethazine, proclorperazine, droperidol
Pharmacological agents for preventive treatment of migraine
Candesartan
Metoprolol/propanolol/timolol
Topiramate
Valproate
CGRP mAbs : erenumab
Probable: amitryptyline, venlafaxine, nadolol, atenolol, lisinopril
Triptan MoA, side effect, monitoring, contraindications
Selective agonist at 5-Ht1b and 5-HT1d, helps vasoconstrict intracranial extracerebral blood vessels, inhibit vasoactive peptide release and inhibit nociception neurotransmission (reduce inflammation and signals associated with pain)
taken early in an migraine attack works best
Try another triptan if one does not work
second dose of triptan within 48 hour of reoccurence of migraine will help resolve migraine
CI: stroke/TIA, ischemic coronary artery, coronary artery vasospasm, uncontrolled hypertension, peripheral vascular disease, GI ischaemjia, hemiplegic or basilar migraine
Concomittant use of ergot-type meds within 24 hours or 2 weeks of discontinuation of MAO-A inhibitor therapy
Cafergot MoA, side effect, monitoring, contraindications
5-HT-1B/1D vasoconstriction, inhibition of norepinephrine uptake and alpha-adrenoreceptors: prolonged vasoconstriction
caffeine > hjelps vasoconstrict cerebral vasculature an enhance GI absorption of ergotamine by decreasing gastric pH
CI: same as triptans (CVS-related conditions), use of triptan within 24hr, use of MAO-I within 2 weeks and potent CYP3A4 inhibitors (e.g. macrolides, protease inhibitors)
CGRP mAbs (Erenumab)
What is medication overuse headache?
Paracetamol or 1 or more NSAID on >= 15 days/months for >3 months
Triptan or >=1 opioid on >= 10 days/month for >3 months
How to prevent medication overuse headache
Modifiable lifestyle factors
