Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Neuro Block Pharm > Headache > Flashcards

Headache Flashcards

1
Q

Types of headaches

A
  • Migraine
  • Tension-type
  • Cluster
  • Daily persistent (new and chronic)
  • Medication overuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Red Flags for HA (8)

A
  1. sudden onset of headache, or severe persistent headache that reaches maximal intensity within a few seconds or minutes after the onset of pain (“thunderclap”, “worst headache of my life”)
  2. A worsening pattern
  3. Focal neurologic symptoms other than typical visual or sensory aura
  4. Fever associated with headache
  5. Any change in mental status, personality, or fluctuation in the LOC
  6. Rapid onset of headache with strenuous exercise, especially when minor trauma has occurred
  7. Nuchal rigidity or pain
  8. New headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Migraine: Pathophysiology

what is believed to be the cause of auras?

A

Self-propagating wave of neuronal and glial depolarization across cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the migraine phases?

A
  • Prodrome
  • Aura
  • Headache
  • Postdrome (recovery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when does the prodrome phase typically start?

what are some symptoms associated with prodrome phase?

A

o Usually starts 24-48 hours before pain

o Some symptoms: euphoria, depression, irritability, food cravings, constipation, neck stiffness, increased yawning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do auras typically present

A

o Most are visual: bright spots, shapes, visual field loss

o Others: tingling  numbness, language/dysphasia, motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is the headache phase in migraines? (type of pain, associated symptoms, etc.)

A

o Usually unilateral, throbbing/pulsatile
o Ranges in severity
o Can be accompanied by nausea/vomiting
o May also have photo-/phonophobia, osmophobia, cutaneous allodynia
o Usually lasts for ~4 hours to several days if untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the postdrome phase of migraines

A

o After headache resolves
o Patient may feel exhausted, elated, or euphoric
o Some report sudden head movements that cause pain at location of previous headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some migraine triggers?

A
  • Emotional stress (80 percent)
  • Hormones in women (65 percent)
  • Not eating (57 percent)
  • Weather (53 percent)
  • Sleep disturbances (fluctuations in sleep also) (50 percent)
  • Odors (44 percent)
  • Neck pain (38 percent)
  • Lights (38 percent)
  • Alcohol (38 percent)
  • Smoke (36 percent)
  • Sleeping late (32 percent)
  • Heat (30 percent)
  • Food (27 percent)
  • Exercise (22 percent)
  • Sexual activity (5 percent)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Abortive/Symptomatic Therapy

what are some mild analgesics used for abortive/symptomatic therapy?

A
  • APAP, NSAIDs, ASA
  • Combinations:
    some OTC/Rx with ASA/APAP/Caffeine
    Some Rx with APAP or ASA + butalbital +/- caffeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Butalbital is a short- to intermediate-acting ________

A

barbiturate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are some effects of Barbiturates

A

depress the sensory cortex, decrease motor activity, alter cerebellar function, and produce drowsiness, sedation, hypnosis, and dose-dependent respiratory depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

there are some combo drugs with APAP or ASA + butalbital +/- caffeine

If the Rx is with ASA C-III controlled substance, what is the medication?

A

Fiorinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

there are some combo drugs with APAP or ASA + butalbital +/- caffeine

If the Rx is with APAP and is not controlled substance, what is it called?

A

Fioricet, Esgic-Plus, Dolgic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Triptans MOA

A

Serotonin 1b/1d agonists
o Inhibits release of vasoactive peptides
o Promotes vasoconstriction
o Blocks pain pathways in brainstem
o Inhibits transmission in trigeminal nucleus caudalis (blocks afferent input)
o May also activate 5-HT 1b/1d receptors in descending brainstem pathways to inhibit dural nociception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is considered first-line for abortive therapy if mild analgesics fail?

A

triptans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

choosing a triptan for a patient is usually based on what things?

A

Choice based on route of administration, cost, personal preference, PK differences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the names of triptan products (drug names)?

A
  • Almotriptan (Axert): tablet only
  • Eletriptan (Relpax): tablet only
  • Frovatriptan (Frova): tablet only
  • Naratriptan (Amerge): tablet only
  • Sumatriptan + Naproxen (Treximet): tablet only
  • Rizatriptan (Maxalt, Maxalt MLT): tablet and dispersible tablet
  • Sumatriptan (Imitrex, Alsuma): tablet, nasal spray (solution and powder), subcutaneous injection, transdermal patch
  • Zolmitriptan (Zomig, Zomig ZMT): tablet, nasal spray, dispersible tablet
  • Some products/dosage forms still brand only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

if you want to prescribe a triptan that is not in tablet form, what could you prescribe?

A
  • Sumatriptan (Imitrex, Alsuma): tablet, nasal spray (solution and powder), subcutaneous injection, transdermal patch
  • Zolmitriptan (Zomig, Zomig ZMT): tablet, nasal spray, dispersible tablet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

triptans are best dosed when?

A

Best if used early in course of attack (within first few minutes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if there is no relief after taking first triptan medication, when can you take another one?

A

Can repeat in 2 hours (except naratriptan 4 h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the typical max dose for triptans?

A

All have max dose/24 period (usually 2 doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Triptans ADRs with PO administration?

A 
paresthesias; 
asthenia and fatigue;
flushing;
 feelings of pressure, tightness, or pain in the chest, neck, and jaw; 
drowsiness; 
dizziness; 
nausea; 
and sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Triptans ADRs with subcutaneous administration?

A

irritation at the site of injection (transient mild pain, stinging, or burning sensations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Triptans ADRs with Intranasal administration?

A

bitter taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Triptans: Limitations of Use

Rare but serious cardiac events, including coronary artery vasospasm, transient myocardial ischemia, atrial and ventricular arrhythmias, and myocardial infarction, predominantly in patients with risk factors for coronary artery disease.

why can these events occur?

A

triptans cause vasoconstriction!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

contraindications for triptans (8)

A
  1. Hemiplegic or basilar migraine
  2. Known or suspected ischemic heart disease- Angina, MI, vasospasm, Prinzmetal’s angina, etc.
  3. Cerebrovascular syndromes- Stroke, TIA
  4. Peripheral vascular disease- Including ischemic bowel disease
  5. Uncontrolled HTN
  6. Use of another 5-HT1 agonist within 24 hours due to risk of serotonin syndrome–> Thought to be rare to nonexistent with SSRI/SNRI medications
  7. Use of ergotamine derivative within 24 hours
  8. Use of MAOI (usually within 2 weeks) (except eletriptan, frovatriptan, naratriptan)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

it patient experiences significant nausea/vomiting with PO triptan medication, what should you do?

A

consider parenteral, nasal, or dispersible formulation

also Can pre-treat with antiemetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

triptan with Highest consistent success

A

Rizatriptan, eletriptan, and almotriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

triptan that is -Most likely to produce short-term and sustained benefit

A

Eletriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

triptans that are similar orally?

A

Sumatriptan, rizatriptan, eletriptan, almotriptan, zolmitriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

triptans with Slower onset of action and lower efficacy?

A

Naratriptan and frovatriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

if patients have a sulfa allergy which triptan should they avoid?

A

Almotriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

when should you avoid use of Almotriptan

A

Avoid if renal/hepatic impairment + concomitant 3A4 inhibitor
possibly sulfa allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

when should you avoid use of Eletriptan

A

Avoid use if within 72 hours of 3A4 inhibitors such as –azole antifungals, clarithromycin, ritonavir, nelfinavir

*High potential for DDI with 3A4 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

which triptan has the fastest onset of action

A

Rizatriptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

the taking rizatriptans, you Must adjust dose down if there is concomitant use of what drug?

A

propranolol

propranolol (increases rizatriptan levels by 70%)

38
Q

what two Antiemetics are DA antagonist

A 
o	Metoclopramide (Reglan)  given IV
o	Promethazine (Phenergan) or prochlorperazine (Compazine) given IV or IM
39
Q

what two Antiemetics are 5-HT3 antagonist

A 
o	Ondansetron (Zofran)
o	Granisetron (Sancuso; Sustol)
40
Q

these medications Can be monotherapy or adjunct for migraine pain as well as emesis

A

Antiemetics

41
Q

DA Antagonist Antiemetics

Can be dosed with______ to prevent akathisia and acute dystonic reactions

A

IV diphenhydramine

42
Q

DA Antagonist Antiemetics and diphenhydramine can cause what cardiac side effect?

A

QT prolongation

43
Q

Ergots MOA

A

Bind to 5-HT 1b/1d receptors just as triptans do

44
Q

when are Ergots used for HA?

A

Reserved for triptan failure

45
Q

name of medication in Ergots class

A

Dihydroergotamine (DHE 45, Migranal)

46
Q

medication name that can be used as Adjunct Therapy for headache?

A

Dexamethasone

47
Q

ergots come in IV/IM/nasal formulations and might be used for ____ therapy

A

acute abortive

48
Q

Dexamethasone has been Shown to be helpful in the acute setting to reduce _____.

A

headache recurrence

49
Q

should Avoid overuse of Dexamethasone because it can lead to _______

A

glucocorticoid toxicity

50
Q

when is Preventive Therapy for Migraines indicated?

A 
o	Frequent attacks
o	Long-lasting attacks
o	Significant disability
o	Uncommon migraine types/conditions
	Hemiplegic migraine
	Basilar type migraine
	Migraine with prolonged aura
	Migrainous infarction
o	Predictable onset:  i.e., menstrual migraine
51
Q

if Preventive Therapy for Migraines is unresponsive, what should you do?

A

May have to switch between drug classes if unresponsive

52
Q

Preventive Therapy for Migraines Usually requires titration over ______ to see maximal effectiveness

A

weeks to months

53
Q

there are Relatively few drugs with FDA indication for preventative migraine therapy, so many drugs used off-label for prophylaxis. what are some examples of these medications?

A

Propranolol, timolol, valproate, topiramate

54
Q

drug classes for preventative migraine therapy (7 classes)

A
  1. Antihypertensives: BBs, CCBs, ACEIs/ARBs
  2. Antidepressants: TCAs
  3. Anticonvulsants
  4. Calcitonin gene-regulated peptide (CGRP) 5. antagonists
  5. Botulinum toxin
  6. Butterbur extract
55
Q

limitations for antihypertensives used for preventative migraine therapy

A

caution in over 60, smokers, erectile dysfunction, PVD, Raynaud’s syndrome/disease, bradycardia/hypotension, asthma, DM, cardiac conduction disturbances, pregnancy

56
Q

most common CCB used for preventative migraine therapy?

A

verapamil

57
Q

common beta blockers used for preventative migraine therapy?

A

metoprolol, propranolol, timolol, nadolol, atenolol

58
Q

which TCAs (antidepressants) are used for preventative migraine therapy?

A

amitriptyline, nortriptyline, doxepin

59
Q

limitations for Antidepressants (TCAs) used for preventative migraine therapy

A

sedation, anticholinergic effects, weight gain, use in elderly

60
Q

which Anticonvulsants are used for preventative migraine therapy?

A

o Valproate: avoid in child-bearing age women if possible
o Topiramate: caution in child-bearing age women
o Gabapentin

61
Q

which anticonvulsant should you use for preventative migraine therapy if you have a female patient that is child bearing age.

A

Gabapentin

62
Q

what is the name of the drug that is a Calcitonin gene-regulated peptide (CGRP) antagonists used as preventative migraine therapy treatment

A

Erenumab (Aimovig)

63
Q

CGRP mediates________ pain transmission and vasodilatory component of neurogenic inflammation

A

trigeminovascular

64
Q

how is Erenumab (Aimovig) dosed?

A

Monthly subcutaneous administration

65
Q

Botulinum toxin only has evidence for chronic migraine (>15 days per month for at least 3 months) NOT _______ migraines

A

episodic migraines

66
Q

why is Butterbur extract not usually recommended as preventative migraine therapy

A

not usually recommended due to lack of long-term safety and regulation

Contains alkaloids that can be hepatotoxic and potentially carcinogenic

67
Q

what medications are good first-choice options for treating tension headaches?

A

Simple analgesics are first-choice

o	APAP (good in pregnancy), ASA, NSAIDs
o	****Rx v. OTC
o	IBU (200-400 mg), naproxen (220-550 mg) or ASA (650-1000 mg)
68
Q

when treating tension headaches, analgesics with a combo of ________ might help but can increase ADRs

A

caffeine

69
Q

in treating tension headaches, you should AVOID combinations of analgesics with ______.

A

butalbital or opioids or muscle relaxants

70
Q

in treating tension headaches, IM _______ is good option if presenting to facility

A

ketorolac

71
Q

what are some Nonpharmacologic therapy first-line options for treating tension headaches

A

relaxation, cognitive-behavioral therapy, biofeedback, acupuncture, PT, etc.

72
Q

which drug class has the most evidence for being used as preventative therapy for tension headaches

A

TCAs

73
Q

describe cluster headaches

A

Short-lasting, very severe pain, usually unilateral
Typically accompanied by autonomic symptoms- Ipsilateral tearing and/or rhinorrhea
Often occur many times per day over several days

74
Q

first line therapy for cluster headaches

A

Oxygen: 100% via non-rebreather at 12-15 L/min

75
Q

patients with what comorbidity may need to avoid first line therapy for cluster headaches

A

first line therapy is oxygen, so Only limitation is with COPD patients where O2 might lead to hypercapnia

76
Q

when treating cluster headaches, _________ can be sued if response is not complete with O2 or if not available

A

Subcutaneous sumatriptan

77
Q

what are some alternatives that can be used for Subcutaneous sumatriptan when treating cluster headaches?

A

IN sumatriptan, IN zolmitriptan, oral zolmitriptan

ergotamine formulations are also available for second-line options very early in the attack

78
Q

drug of choice for preventative therapy in cluster headaches

A

verapamil

79
Q

second line options for preventative therapy in cluster headaches

A

glucocorticoids, lithium, valproate, topiramate, gabapentin

80
Q

what is medication overuse headache caused by?

A

Caused by use of medications too frequently which results in “rebound” headaches

81
Q

Pathophysiology of medication overuse headache is uncertain but believed to be due to?

A

o Genetic predisposition
o Central sensitization like in migraines
o Biobehavioral factors

82
Q

which medications can cause medication overuse headache

A

All acute symptomatic medications used to treat HA have potential to cause MOH

83
Q

medications with the highest risk to cause medication overuse headache

A

o Butalbital-containing combination analgesics
o APAP
o Opioids
o ASA

84
Q

medications with the Intermediate to high risk that can cause medication overuse headache

A

Triptans/ergotamine derivatives

85
Q

medications with the lowest risk to cause medication overuse headache

A

NSAIDs

86
Q

medication overuse headache diagnosis criteria

A

o HA > 15 days per month
o Regular overuse of more than three months with acute/symptomatic drugs-
1. Ergotamine, triptans, opioids, or combination analgesics > 10 days per month for more than three months
2. Simple analgesics >15 days per month for more than three months

87
Q

medication overuse headache treatment

A
  • Patient education as to cause and how to prevent
  • Withdraw offending drug therapy
  • Start preventive medication according to HA type
88
Q

when treating medication overuse headache, how long may it take for the HA to resolve?

A

May take weeks for headaches to resolve

89
Q

when treating medication overuse headache, Withdrawal of offending medication may occur as outpatient or may require admission for inpatient withdrawal. when would admission for withdrawal be indicated?

A

patients taking barbiturates, opioids, or tranquilizers

90
Q

options for Bridge therapy when treating medication overuse headache

A

o Long-acting NSAID, prednisone: good for triptan/APAP overuse
o Clonidine helps with opioid overuse

91
Q

how should you approach treatment for Chronic Daily Headaches (CDH)

A

Identify the phenotype and treat accordingly

*Neuro Block Pharm (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions