Headache Flashcards
Characteristics of Tension type ha?
30 minutes to 7 days, with pressing. nonpulsatile pain, mild-mod intensity, usually bilateral. 5:1
characteristic of migrie without aura?
4-72 hours, unilateral, occ bilateral, pulsating, mode- severe. agg w/activity, n/v. photophobia, phonophobia.
Character of migraine with aura
migraine + aura symptoms over 4 minutes - two or more symptoms in succession. dread and anxiety, fatigue, anxiety. GI upset, visual, olfactory alteration. aura should end in 1 hour.
Cluster headache symptoms?
occur daily in groups or clusters. clusters can last weeks to months. then disappear. wakes in sleep within 1 hour. HA behind eye with stead intense severe pain lasting 15min- 30 min. often occurs with increased lcarimation, conjuctival infection, ptosis, nasal stuffy.
Headache Red Flags?
systemic symtpoms - fever. WL
neuro - confusion, NRigidity, hypetension, papilledema, CN dxn, abn motor fxn.
Onset- sudden abrupt, thunder! with exertion soughing or sneezing.
> 50 years ol
What medication works as prophylaxis for both tension HA and migraines?
triptans
Abortive therapy for cluster HA?
NSAIDS
triptans
high flow oxygen
what injectable forms tx available?
abortive ergots and triptan
ergot can be given IV
triptan IM
What nasal sprays available?
supatriptan (imitrix)
zolmitriptan
droergotamine
what antiemetic commonly used?
prochlorperazine (compazine), odndanstron, reglan (limit this one though since EPS)
MOA of triptans?
SSR agonist and at 5 ht1D serotonin receptor site. vasoconstricting potential
CI of triptans among what conditions?
angina, CAD, pregnancy, recently used ergots. caution with MAOI or SSRI
MOA of ergotamines?
5HT1A and 1D agonist. alter cerebral flow. vasocontrictor effect.
CI of ergots?
pregnancy, CAD
Treatment of tension HA?
NSAIDS (acetimnophen, *Excedrine maigrain - ASA + acet + caffeine)
triptan
Treatment of cluster HA?
1) NSAID
2) systemic corticosteroids - severe cases
Abortive Treatment of migraine?
1) NSAID
* acetiminophen
* ASA
* naproxen sodium is better than others often
* Excedrine maigrain - ASA + acet + caffeine
2) ergot
3) triptan
4) floricet - combo of ceffeine + butalbital + acetim
5) NEuroepileptics - first generation such as procholorperazine (compazine), promethazine (phenergan).
6) . systemic corticosteroids - severe cases
7) opioids - hydrocodone and oxycodone (migraine rescue)
How long before prophyalxis effects seen in prevention?
1-2 mo
What must occur before prophylaxis can be implemented?
estrogen, prog, vasodilators need to eliminated or limited.
Prevention migraines?
triptans ergots? BB - antiepileptics some antidepressants (Tryciclics, ans SSNRI)
what BB has no benefits for migraine prevention?
acebutolol.
which BB have effect for migraine prevention
metoprolol and propranolol. atenolol and nadolol a little effect.
What antiepileptics effective for migraine prevention?
- divalproez sodium, sodium valproate, topiramate.
What AED is not recommended for prevention of migraines?
lamotrigine.
