Headache

Question 1

General categories of Abortive Migraine Therapy

Answer 1

Analgesic, NSAIDs, Combo analgesics, 5-HT Receptor Agonists, Ergotamine Preparations, Ergot Derivatives, Opioid Combination, Anti-emetics, Steroids

Question 2

5-HT 1b/1d receptor agonists MOA and name suffix

Answer 2

MOA: direct vasoconstriction, also block neurogenic inflammation
end in -triptan

Question 3

5-HT 1b/1d receptor agonists AEs and CIs

Answer 3

AE: dizziness, warmth sensation, chest fullness, N,
rare:angina, arrythemia, MI
CI: CV disease, uncontrolled HTN, PVD, hemiplegic and basilar migraine, within 14 days of MAOI or within 24 hours of ergotamine, DHE, or methysergide

Question 4

Ergotamine Preparations MOA

Answer 4

stimulate 5-HT1 receptors which leads to blockade of neurogenic inflamm, constrict IC blood vessels

Question 5

Ergotamine Preparations AEs and CIs

Answer 5

AE: N/V, vasospasm, muscle aches, tremor, tingling, rebound HA
CI: CV disease, PVD, Pregnancy X, cerebrovascular disease
Max dose to prevent ergotism: vasoconstriction complications such as MI, hepatic necrosis, bowel/brain ischemia

Question 6

Ergot Derivative AE and CIs

Answer 6

Diarrhea, muscle cramps, no rebound HA; better tolerated than ergotamine preps
Same CI as Ergotamine Preps (CV ds, PVD, pg.X, cerebrovascular ds)

Question 7

When should you evaluate for unrecognized CAD before Triptan use and what should you do with these people

Answer 7

Postmenopausal women, men >40, and pts w/ uncontrolled CAD risk factors
Pts at risk should receive first dose under medical supervision

Question 8

4 Criteria for Medication Overuse HA

Answer 8

A: HA present on >15 days/month fulfilling C and D
B: regular overuse for >3 months of drugs that can be taken for tx of HA
C: HA has developed during med overuse
D: HA resolves to its previous pattern within 2 months after discontinuation of overused med

Question 9

When should you consider prophylactic therapy for HA

Answer 9

frequent HA (>2/wk), migraine interferes with pts daily routines despite acute tx, CI, AE, failure, or overuse of acute therapies, pt. preference, presence of uncommon migraine conditions

Question 10

Prophylactic Therapy for HA

Answer 10

Beta Blockers
ARBs
ACEs
Ca channel inhibitors
Tricyclic antidepressants
SNRI
AEDs
NSAIDs

Question 11

Natural products safe for HA

Answer 11

caffeine, chasteberry, magnesium, feverfew, riboflavin, coenzyme Q10, melatonin

Question 12

Abortive tx for Cluster HA

Answer 12

Oxygen 100%
Sumatriptan, Zolmitriptan
Dihydroergotamine, Ergotamine, Ergo/Caffeine
Corticosteroid

Question 13

Prophylactic tx for Cluster HA

Answer 13

Verapamil
Lithium
Prednisone
Ergotamine

Question 14

Pharm tx for Tension HA

Answer 14

Simple analgesics

*meds should not be taken more than 2 days/week to prevent chronic tension HA