Headache Flashcards
HA Pathophysiology
- not well understood
- neuronal hypothesis: due to imbalance in modulation of nociception and blood vessel tone
Goals of Long-Term Migraine Therapy
- reduce migraine frequency, severity, disability
- reduce reliance on poorly tolerated/ineffective txs
- improve QOL
- prevent HA
- avoid escalation of HA med use
- educate pts on dz management
- reduce HA-related distress and psych sxs
Goals of Acute Migraine Treatment
- treat migraine attacks rapidly and consistently w/o recurrence
- restore pt’s ability to function
- minimize use of backup and rescue meds
- optimize self-care for overall management
- be cost-effective in overall management
- cause minimal or no AEs
Nonpharm Migraine Tx
- pt education: HA diary, identify and avoid triggers, establish therapy efficacy and need for prophylaxis, understand when/how to use meds
- behavioral medicine: cognitive behavioral therapy, relaxation therapy, biofeedback
What is first line treatment for mild to moderate migraine?
NSAIDs: aspirin, ibuprofen (Motrin, Advil), naproxen
If NSAIDs don’t work for migraine tx, what is the next option?
combination analgesics
eg APAP/ASA/caffeine (Excedrin Migraine)
AEs of Excedrin Migraine (APAP/ASA/caffeine)
may cause MOH
What migraine tx option should be considered for pregnant patients?
simple analgesic: acetaminophen
AEs of the Triptans/5HT Receptor Agonists
- dizziness
- sensation of warmth
- chest fullness
- nausea
- rare: angina, arrhythmia, cerebral and myocardial ischemia
CIs of the Triptans
- CV dz: angina, hx MI, uncontrolled HTN, CVA, PVD, hemiplegic and basilar migraine
- don’t use w/in 14 days of MAOI or 24hrs of ergotamine, DHE, methysergide
Ergotamine AEs
- N/V frequent
- possible vasospasm
- muscle aches
- tremor, tingling of extremities
- rebound HA
Ergotamine CIs
- CV dz
- PVD
- pregnancy
- cerebrovascular dz
When should triptans be used?
for moderate to severe migraine (or mild unresponsive to simple analgesics and NSAIDs)
When should ergotamines be used?
moderate to severe migraine
Dihydroergotamine AEs
- diarrhea
- muscle cramps
Dihydroergotamine CIs
- CV dz
- PVD
- pregnancy
- cerebrovascular dz
When should dihydroergotamine be used?
moderate to severe migraine
What drugs are considered rescue therapy for migraine treatment?
- opioid combos (ASA/APAP with narcotics)
- corticosteroids
What can be given to treat N/V and decrease pain associated w/ migraines?
- metoclopramide (Reglan)
- propchlorperazine (Compazine)
What type of patients require caution when using triptans?
unrecognized CAD in:
- postmenopausal women (higher risk of CAD)
- males > 40
- patients w/ uncontrolled CAD risk factors (HTN, dyslipidemia, age, fam hx, smoking)
Rank triptan dosage routes in order of onset time.
SQ is fastest, then nasal, then PO
Rank triptan dosage routes in order of cost.
faster onset = greater cost so SQ is most expensive, PO least
When should PO triptans be avoided?
when pt has N/V
Mild HA
patient is aware of HA but able to continue daily routine with minimal alteration
