Headache

Question 1

what are the three high risk HAs

Answer 1

subarach hemorrhage
stroke
bacterial meningitis

Question 2

Medications that cause _______ commonly trigger migraines

Answer 2

vasodilation

Question 3

abortive migraine therapies work best if given ______(when), with __________(dose); however many oral agents are ineffective d/t __________

Answer 3

best if given early on in the course of the HA
Large single dose more effective than repetitive small doses
migraine induced gastric stasis

Question 4

Use ________ meds in severe migraines or those who don’t respond to ________

Answer 4

migraine specific medications

or those who don’t respond the NSAIDs

Question 5

What are the 2 migraine specific drug txs

Answer 5

ergot derivatives

5-HT1B/1D agonists

Question 6

what 4 migraine non-specific txs are there

Answer 6

NSAIDs
Analgesics
Antiemetics
Corticosteroids

Question 7

______ are 1st line for mild-mod migraines

Answer 7

NSAIDs

Question 8

what are the 3 NSAIDs used for mild-mod migraine

Answer 8

ASA
naproxen
ibuprofen
(excedrin migraine)= APAP + ASA +caffeine

Question 9

Intranasal _________ is a nonspecific (not 1st line) tx for migraine

Answer 9

lidocaine

Question 10

_______ are reserved for severe migraines unresponsive to other txs

Answer 10

opioids (butorphanol nasal spray)

Question 11

barbiturates in combo with _______ or _______ may be used for mod-severe migraine, but have a high potential for overuse

Answer 11

analgesics or codeine

Question 12

what is the barbiturate used with asprin and caffeine for migraine tx? what are the possible drug interactions?

Answer 12

butalbital
(causes CNS depression)

effects reduced by barbiturates: phenothiazide, quinidine, cyclosporine, theophylline, and beta blockers
effects increased by barbiturates: chloramphenicol, benzodiazepines, CNS depressants.

Question 13

what 3 antiemetics can be used as a monotherapy to tx migraine

Answer 13

metoclopramide (IV)
chlorpromazine (IV/IM)
prochlorperazine

Question 14

antiemetic MOA and sfx(also how to manage these).

Answer 14

MOA: dopamine antagonist

sfx: QT prolongation, sedation, and dystonia and akathisia(restlessness)
mgmt: for dystonia and akathisia use diphenhydramine IV

Question 15

MOA of Erot alkaloids

Answer 15

nonselective 5-HT(serotonin) agonist causes vasoconstriction of cranial blood vessels

Question 16

name the 2 ergot alkaloids

Answer 16

Ergotamine tartate (PO, SL, rectal)
dihydroergotamine (injection or spray)

Question 17

Ergotamine acute sfx (3)

Answer 17

N/V (pretreat with antiemetic)
chest tightness
diminished periph pulses

Question 18

ergotamine chronic sfx (4)

Answer 18

ischemia
HTN
renal DO
tachy/brady

Question 19

CI for ergotamine (5)

Answer 19

coronary or periph vasc dz
sepsis
pregnancy
renal/hepatic failure
*use of triptans w/in last 24hrs (b/c both vasoconstrict)

Question 20

triptans MOA

Answer 20

selective 5-HT agonist (vasoconst in brain)

Question 21

______ are 1st line for mod-severe migraine

Answer 21

Triptans

Question 22

name the 3 Triptans

Answer 22

Sumatriptan (PO, SQ, nasal)
Rizatriptan (oral)
Zolmitriptan (Oral nasal)
(taste perversion from nasal spray)

Question 23

triptan sfx (4)

Answer 23

chest tightness
dizziness
fatigue
nausea

Question 24

5 CI for triptans

Answer 24

Ergot in last 24hrs (inc vasoconstriction)
MAOI in last 2 wks (inhib clearance of triptan=serotonin syndrome)
Ischemic heart/CV dz
uncontrolled HTN
SSRI (serotonin syndrome)

Question 25

5 sx of serotonin syndrome

Answer 25

hyperthermia musc rigidity myoclonus rapid change in mental status and vitals

Question 26

_______ and _______ are 1st line prophylactic tx for migraines

Answer 26

``` beta blockers (esp propranolol) TCAs (esp amitriptyline) ```

Question 27

Beta blockers CI (3)

Answer 27

periph vasc dz depression asthma

Question 28

TCA CI

Answer 28

glaucoma pregnancy (black box: inc suicide risk in teens)

Question 29

Venlafaxine MOA

Answer 29

SNRI (inhib SE and NE reuptake)

Question 30

Venlafaxine CI and cautions

Answer 30

BLACK BOX: suicide | CI: MAOI

Question 31

Valproic acid and divalproex sodium are ________ drugs which can treat migraine (NOT 1st line)

Answer 31

anticonvulsants

Question 32

MOA of anticonvulsants and CI

Answer 32

inc GABA availability | CI:liver dz

Question 33

Carbamazepine, topiramate, gabapentin

Answer 33

anticonvulsants that may be used to tx migraine

Question 34

Methylsergide

Answer 34

reserved for SEVERE migraines perph SERotonin inhib but CENTRAL SERotonin agonist Serious sfx: fatal pulm fibrosis

Question 35

Botulinum Toxin

Answer 35

not FDA approved (but shows promise for migraine) | inhib Ach release at presynaptic cholinergic jxn

Question 36

name 5 tx for intractable migraines

Answer 36

``` DHE Sumatriptan Prochlorperazine or chlorpromazine narcotics corticosteroids ```

Question 37

3 drug tx classes for tension-type HA

Answer 37

- analgesic +/- caffeine - sedatives (butalbital) - prophylactic (TCA)

Question 38

what 4 analgesics are used +/- caffeine for tension-type HA

Answer 38

APAP ASA Ibuprophen Naproxen

Question 39

5 tx for acute cluster HA

Answer 39

``` 100% oxygen Imitrex SQ Ergotamine+/- caffeine DHE-45 lidocaine nasal spray ```

Question 40

5 prophylactic txs for cluster HA

Answer 40

``` verapamil prednisone ergotamine methylsergide lithium ```