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pharm 2 2 > Headache > Flashcards

Headache Flashcards

1
Q

What are the 3 types of headaches?

A

Primary, Secondary, Medication overuse

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2
Q

What are the types of primary headaches?

A
  • Migraine
  • Tension
  • Cluster
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3
Q

What are types of secondary headaches?

A
  • Dental pain
  • Subarachnoid hemorrhage
  • Brain tumor

symptom of a secondary abnormality

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4
Q

What is first line treatment for migraine?

A

Simple analgesics- NSAIDS, APAP, caffeine

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5
Q

What are a/e of simple analgesics?

A

GI upset, somnolence, dizziness

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6
Q

Use caution in what patients with simple analgesics?

A
  • PUD
  • Renal disease
  • History of MI or stroke
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7
Q

Why caution with opiods?

A
  • rebound headaches

- addictive potential / dependence

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8
Q

What about APAP alone?

A

ineffective in acute migraine treatment

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9
Q

How does Triptan work?

A

Serotonin receptor agonist, results in vasoconstriction of intracranial arteries. It blocks pain pathway in brainstem

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10
Q

Contraindications for Triptan?

A
  • Uncontrolled HTN
  • History of ischemic heart disease
  • Cerebrovascular disease
  • Combination with MAOI
  • Pregnancy? (Cat C)
  • SSRI
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11
Q

Caution with what med and Triptan?

A

SSRI, small risk of serotonin syndrome

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12
Q

Most triptans last how long?

A

3 hours

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13
Q

Which triptan lasts a long time?

A

Naratriptan – 26 hours!

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14
Q

A/E of triptans?

A
  • chest symptoms “Triptan sensation” tightness, pressure, heaviness
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15
Q

How do ergot alkaloids work?

A

non-selective serotonin agonist, causes vasoconstriction of intracrainial blood vessels

LAST LINE USUALLY

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16
Q

Would you put patient on triptan & ergot alkaloid?

A

NO, both same mechanism

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17
Q

A/E of ergot alkaloids?

A
  • Ergotism (rare) psychosis with convulsions and gangrene in the toes
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18
Q

What is ergot derivative?

A

LSD

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19
Q

What is the common ergot?

A

DHE nasal spray

20
Q

Contraindications for ergot?

A
  • Coronary / cerebral / PV disease
  • Uncontrolled HTN
  • Sepsis
  • Hepatic and renal failure
21
Q

Risk with ergot meds?

A

Rebound headaches (like opioids)

22
Q

What are another types of med for migraines?

A
  • Anti-emetics
  • Corticosteroids
  • Valproate (valporic acid, anti epileptic)
23
Q

What should you consider for status migrainosis?

A
  • DHE (ergot)

- Valproate

24
Q

What is status migrainosis?

A

Migraine that has not broken in over 72 hours (usually classified if patient failed multiple therapies)

25
Q

Who should get migraine prophylaxis?

A
  • 2 or more abortive therapies in a week
  • More than 15 migraines in a month
  • Contraindications or unsatisfied with abortive treatments
26
Q

Migraine prophylaxis options?

A
  • Amitryptiline
  • Beta blockers (propranolol, timilol)
  • Calcium Channel Blocker (Verapamil)
  • Antiepilectics
27
Q

Who should not get Beta Blocker for migraine prophylaxis?

A
  • Asthma
  • Depression

GOOD for patent with HTN

28
Q

Who should not get amitriptyline for migraine prophylaxis?

A
  • Mania

GOOD for patient with depression

29
Q

Who should not get CCB prophylaxis?

A
  • Depression

GOOD for HTN, angina

30
Q

Who should not get anti-epileptics for migraine prophylaxis?

A
  • Liver disease
31
Q

What is an uncommon migraine prophylaxis?

A
  • Botox

Blocks neuromuscular conduction by binding receptor sites on nerve terminals, prevents release of acetylcholine

32
Q

What is the most severe type of primary headache?

A

Cluster headache

Treat with ABORTIVE + PROPHYLAXIS

33
Q

First line abortive treatments for cluster headaches?

A
  • Oxygen (not patient friendly!)

- Triptans

34
Q

What else can you use for cluster headaches?

A

Ergotamine derivatives (DHE)

35
Q

What prophylactic treatment for cluster headaches?

A
  • CCB (first line)
  • Lithium
  • Corticosteroids
  • Melatonin
  • Gabapentin / Topiramate
36
Q

Difficulty with CCB prophylaxis?

A

Takes full effect in 4-6 weeks

37
Q

Difficulty with lithium?

A

Monitoring, usually last line treatment

38
Q

What is most common type of headache?

A

Tension type

39
Q

Abortive treatment for tension?

A
  • Analgesics: NSAIDS, APAP, ASA

NSAIDS = mainstay of treatment

40
Q

What are other tension headache abortive?

A
  • Combination products
  • Triptans
  • Muscle relaxants (not strong evidence)
41
Q

Potential triggers of medication overuse headaches?

A
  • Narcotics
  • Triptans
  • Ergotamine
  • Benzos
  • Caffeine
42
Q

Classification for medication overuse?

A

15 or more days a month of headache

43
Q

First step for medication overuse HA?

A

Stop / decreasing amount of that medication

44
Q

Second line for medication overuse?

A
  • Prednisone
45
Q

Third line for medication overuse?

A
  • DHE

pharm 2 2 (8 decks)

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