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Pharmacology II > Headache > Flashcards

Headache Flashcards

1
Q

1 cause of daily headache

A

medication-overuse headache or Rebound headache

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2
Q

Which medications are typically to blame for rebound headache?

A
  1. Simple and combo analgesics
  2. Opiates

-Limit acute migraine therapy to fewer than 10 days a month**

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3
Q

Migraine patho

A
  • neuropeptide release leads to dural blood vessel vasodilation
  • neurogenic inflammation
  • trigeminal pain fibers transmit pain
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4
Q

Long term goals of migraine treatment

A
  • Reduce disability
  • Improve quality of life
  • Avoid escalation of headache medication use
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5
Q

Goals for acute migraine treatment

A
  • Treat migraines rapidly and consistently without recurrence
  • Restore ability to function
  • Minimize use of back up and rescue medications
  • Cause minimal or no adverse effects
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6
Q

Analgesic (OTC) migraine therapy

A
  1. Acetaminophen

2. Acetaminophen + ASA + caffeine

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7
Q

NSAID (OTC) antiinflammatory drugs

A
  1. ASA
  2. Ibuprofen
  3. Naproxen
  4. Diclofenac
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8
Q

Triptans (examples and MOA)

A
  1. Sumatriptan (injection*, oral, nasal)
  2. Zolmitriptan (oral, nasal)

MOA: selective agonists of 5-HT

**First line for mild to severe migraine

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9
Q

Ergotamine Tartrate

A
  • Oral with caffeine
  • Rectal suppository with caffeine
  • sublingual

-These are good for people who can’t take the triptans

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10
Q

Ergotamine MOA

A
  • constrict intracranial blood vessels

- Central inhibition of the trigeminaovascular pathway

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11
Q

What are the 3 key actions of Triptans

A
  1. Normalize dilated intracranial arteries by stimulating vasoconstriction
  2. Inhibit vasoactive peptide
  3. Inhibit transmission through 2nd order neurons ascending to thalamus
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12
Q

What is important to remember about the sumatriptan (imitrex) nasal spray?

A

one spray in one nostril only

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13
Q

What should be considered as pretreatment with the ergotamines?

A

consider pretreatment with antiemetic

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14
Q

What do you need to keep in mind about the dihydroergotamine nasal spray?

A

discard open ampules after 8 hours

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15
Q

Adjunct Migraine therapies

A
  1. Metoclopramide (Reglan) [IV]: helpful for acute relief in office or ED. Improves bowel motility to help oral drugs reach small intestine faster
  2. Prochlorperazine (Compazine) [IV or IM]: helpful for acute relief in office or ED. Avoid in parkinson’s disease as this affects dopamine
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16
Q

Triptan ADE

A 
"triptan sensations"
-tightness, 
-pressure
-heaviness
-pain in chest
-neck
or
-throat
17
Q

Sumatriptan indications

A
  1. Migraine

2. Cluster

18
Q

Migraine preventative therapy

A
  • Propranolol**
  • Timolol
  • Divalproex sodium
  • Topiramate

Trial for 2-3 months

19
Q

What drug is taken in the perimenstrual period to prevent menstrual migraine?

A

Frovatriptan

-can also take Ibuprofen (motrin) for menstrual migraine prevention

20
Q

What drug is helpful for migraine with aura and menstrual migraine?

A

Magnesium

side note: OCPs are contraindicated in migraine with aura

21
Q

Prophylactic migraine therapies

A
  • Magnesium
  • MIG-99
  • Riboflavin
  • Melatonin
  • Butterbur
22
Q

Prophylactic managmment of migraine

A

Headaches in predictable pattern (ex. menstrual migraine) –> NSAID or triptain

Healthy or comorbid hypertension or angina–> B-adrenergic antagonist (ex. Propranolol)

Depression or insomina + migraine –> tricyclic antidepressant

Seizure + migraine –> anticonvulsant

23
Q

Tension-Type Headache Tx

A
  1. Cognitive-Behavioral therapy (stress management, relaxation, training)
  2. Acetaminophen
  3. NSAIDs (Ibuprofen, ASA, Diclofenac, Naproxen)
24
Q

Treatment length for tension type headache

A
  • Butalbital - no more than 3 days
  • Combination analgesics (ex. ASA, Acetaminophen, caffeine) - no more than 9 days
  • NSAIDs - no more than 15 days a month
25
Q

Cluster headache: Tx

A

Abortive treatment:

  • 100% O2
  • Triptan (spray or injection, more effective than oral, except zolmitriptan)
  • Ergotamines (IV)

Prophylaxis:
-Verapamil

Pharmacology II (31 decks)

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