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headache Flashcards

1
Q

examples of primary headache

A

migraine, tension type, or cluster and other trigeminal autonomic cephalgias

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2
Q

define secondary headache and give example

A

caused by an underlying medical disorder. medication overuse headache

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3
Q

examples of headache triggers

A

hormonal, environmental, emotional (stress, menstruation, weather, caffiene)

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4
Q

define chronic headache

A

occurs 15+ days/month for 3+ months

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5
Q

define status migrainosus

A

severe and debilitating migraines for 72+ hours

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6
Q

who is brain imaging recommended for diagnosis of migraine headache

A

pts with risk factors of intracranial pathology (acute onset, 55+, abnormal neuological exam)
localized neurological signs (numbness, tingling)
Frequent, prolonged, severe attacks

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7
Q

To classify tension headaches as episodic how often do they occur

A

3 days per month

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8
Q

to classify tension headaches as chronic how often do the occur

A

15+ times per month

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9
Q

What is the most common type of primary headache

A

tension

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10
Q

tension headaches are more common in which gender

A

female

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11
Q

what is the least common type of primary headache

A

cluster

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12
Q

cluster headaches are more common in which gender

A

male

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13
Q

cluster headaches pathophysiology

A

unsure. possibly hypothalamic dysfunction

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14
Q

Causes of cluster headaches

A

genetics

tobacco/alcohol use

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15
Q

how often are episodic cluster headaches

A

lasting weeks to months with remission

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16
Q

how often are chronic cluster headaches

A

1 year without remission or remission less than 1 month

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17
Q

frequency of cluster headaches

A

once every other day to 8 per day

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18
Q

Headache Alarm symptoms

A

acute onset of first or worst headache ever
accelerating pattern of headaches after initial subacute presentation
onset of headache after 50
headache assocaited with systemic illness (fever, N/V, neck stiffness, rash)
headache with focal neurological symptoms or papilledema
new onset headache in patient with cancer or HIV (immunocompromised)

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19
Q

how many attacks to diagnose migraine without aura

A

5+

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20
Q

how many attacks to diagnose migraine with aura

A

2+

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21
Q

how many attacks to diagnose tension type headache

A

10+ attacks on average < 1 per month

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22
Q

how many attacks to diagnose cluster headache

A

5+ attacks on average 1+/day more than half of the time

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23
Q

migraine without aura must have 2+ of these characteristics

A

pain increase or decrease with physical activity
unilateral
pulsating
moderate to severe intensity

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24
Q

migraine with aura must have 1+ of these characteristics with no motor weakness

A 
visual symptoms (+/-) 
sensory symptoms (+/-) 
dysphasic speech, moerate or severe intensity
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25
tension type headache must have 2+ of these characteristics
bilateral nonpulsating mild or moderate
26
cluster headache characteristics
unilateral orbital, supraorbital, or temporal sharp, stabbing, severe
27
migraine without aura must have 2+ of the following other symptoms
``` nausea vomiting photophobia phonophobia osmophobia ```
28
duration of migraine without aura
4 to 72 hours
29
migraine with aura must have 2+ of the following other symptoms
homonymous visual symptoms and/or unilateral sensory symptoms 1 aura develops 5+ minutes prior and/or a second aura develope in 5 minutes after HA start duration 5-60 mintes
30
duration of migraine with aura
5-60 minutes
31
tension type headache must have 2+ of the following other symptoms
no nausea or vomitting AND either photophobia or phonophobia
32
duration of tension type headache
30 minutes to 7 days
33
cluster headaches must have 1+ of the following other symptoms
conjuntival injection and/or lacrimation nasal congestion and/or rhinorrhea eyelid edema
34
duration of cluster headache
15-180 minutes
35
goals of therapy for headache
reduce attack frequency, severity, and disability reduce reliance on ineffective, poorly tolerated acute treatment medications (avoid overuse and dependence of analgesics) improve QOL avoid acute headache medication escalation reduce headache related distress and psychological symptoms reduce frequency and severity within a cluster series delay or eliminate recurrent periods
36
non pharm treatment of headache
``` headache diary avoid exposure to triggers behavioral interventions reduce alcohol and tobacco use accupuncture psychological intervention relaxation techniques ```
37
medications that can trigger headache
nitrates, estrogen/oral contraceptives, nifedipine, ondansetron, indomethacin, cimetidine
38
what medications can cause headaches as withdrawl from overuse
analgesics, Benzos, decongestants
39
behavioral headache triggers
``` fatigue menstruation or menopause sleep excess or deficit stress vigorous physical activiy ```
40
environmental headache triggers
``` flickering lights high altitude loud noises strong smells tobacco smoke weather changes ```
41
food headache triggers
``` alcohol caffeine intake or withdrawl chocolate citrus fruits, bananas, figs, raisins dairy products fermented or pickled products MSG containing (asain, seasoned salt) Saccharin/aspartame (diet soda/food) Sulfites (shrimp) Tyramine (cheese, wine, organ meats) Yeast (breads) ```
42
Pharm treatment for mild-moderate migraine
APAP+ASA+ caffeine; NSAIDS
43
Pharm treatment for moderate-severe or when simple analgesics not effective
Triptans
44
Triptans used to treat migraines
``` almotriptan eletriptan frovatriptan naratriptan rizatriptan sumatriptan zolmitriptan ```
45
AEs of triptans
dizziness, warm sensation, chest fullness, nausea | RARE: ischemic event due to vasoconstriction
46
MOA of triptans
selective 5HT 1B/1D/1F agonists vasoconstriction inhibit inflammation central inhibition of pain
47
Contraindications to all triptans
cardiovascular: ischemic heart disease, angina, mocardial infarction, myocardial ischemia, PVD cerebrovascular: TIA, stroke Uncontrolled HTN within 24 hours of ergot derivatives
48
additional contraindication to eletriptan
use of CYP 3A4 inhibitors within 72 hours (azole antifungals, clarithromycin)
49
additional contraindication to naratriptan
CrCl < 15 and/or severe hepatic impairment
50
Almotriptan brand name
axert
51
eletriptan brand name
relpax
52
frovatriptan brand name
frova
53
naratriptan brand name
amerge
54
rizatriptan brand name
maxalt / maxalt MLT
55
sumatriptan brand name
imitrex
56
sumatriptan/naproxen brand name
treximet
57
zolmitriptan brand name
Zomig / Zomig ZMT
58
Almotriptan routes
oral
59
eletriptan routes
oral
60
frovatriptan routes
oral
61
naratriptan routes
oral
62
rizatriptan routes
oral | ODT
63
sumatriptan routes
subQ | oral
64
Sumatriptan/naproxen route
nasal spray | oral
65
Zolmitriptan routes
oral ODT nasal spray
66
almotriptan drug interactions
ergot derivative
67
eletriptan drug interactions
CYP 3A4 CYP 2D6 ergot derivatives
68
frovatriptan drug interactions
CYP 1A2 | ergot derivatives
69
naratriptan drug interactions
CYPs, ergot derivatives
70
Rizatriptan drug interactions
Ergot derivatives | MAO-A Inhibitors
71
Sumatriptan drug interactions
ergot derivatives | MAO-A inhibitors
72
Zolmig drug interactions
CYP 1A2 ergot derivatives MAO-A inhibitors
73
ergotamine alkaloids used in migraine
dihydroergotamine (DHE) | ergotamine
74
MOA of ergotamine alkaloids
typtaminergic, dopaminergic, alpha adrenergic receptors | vasoconstriction
75
AEs of ergotamines
nausea (give antiemetic)
76
Pregnancy category of ergotamines
X
77
Contraindications with ergotamines
Cardiovascular: ischemic heart disease, angina, MI, myocardial ischemia, PVD Uncontrolled HTN Use within 24 hours of triptans and other serotonin agonists, ergot-like agents Severe hepatic/renal impairment Sepsis Pregnancy/nursing
78
How are opioids used for migraine
rescue therapy
79
when is butorphanol nasal spray used for migraine
when others are contraindicated
80
AEs of opioids
``` sedation drowsiness dizziness n/v constipatoin (nasal congestion/insomnia with nasal spray) ```
81
Which medications are not used in tension type headache
butalbital combos opioids benzos
82
tension headaches are typically treated how
nonpharm (ice pack/massage) and OTC (NSAIDS, APAP)
83
what is given for tension headache if nonpharm/OTC not effective
antidepressant with sedative effects (amitriptyline)
84
What routes are preferred for cluster headache
non-oral
85
What medications are recommended for cluster headache
sumatriptan subQ and zolmitriptan nasal spray
86
4 medications that can be used for cluster
triptans oxygen lidocaine/cocaine hydrochloride octreotide
87
Medication overuse headache occurs how often
15+ days per month
88
what medications contribute to medication overuse headache
``` ergotamine triptans opioids combo analgesics simple analgesics ```
89
how long is a medication taken regularly before medication overuse headache
3+ months
90
How long after d/c medication will medication overuse headache resolve
within 2 months
91
how to manage medication overuse headache
aburpt stop better than taper | TCA
92
Who should get headache prevention
frequent, severe, or lead to significant disability Migraines with neurologic focality APAP/NSAIDs 2+ days/week
93
medications used to prevent migraines
``` beta blockers ACE/ARB Antidepressants Antiepileptics Triptans Alpha agonists ```
94
Which beta blockers are used for migraine prevention
``` propranolol metoprolol timolol atenolol nadolol ```
95
Which ACE/ARBs are used for migraine prevention
lisinopril | candesartan
96
Which antidepressants are used for migraine prevention
amitriptyline | venlafaxine
97
Which antiepileptics are used for migraine prevention
divalproex sodium sodium valproate topiramate carbamazepine
98
Which triptans are used for migraine prevention
frovatriptan zomitriptan naratriptan
99
which alpha agonists are used for migraine prevention
clonidine | guanfacine
100
What medications are used to prevent tension headache
``` similar to migraine TCA muscle relaxants botulinum toxin (severe cases) intranasal capsacin suboccipital steroid injection verapamil lithium melatonin ```
101
What medications can be used to manage headache in pregnancy
APAP antiemetics opioids corticosteroids
102
What headache medications are contraindicated in pregnancy
``` NSAIDs Triptans Ergotamines beta blockers calcium channel blockers antiepileptics ```

Pnt Exam 2 (11 decks)

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