Headache Flashcards
1 cause of daily headache
medication-overuse headache or Rebound headache
Which medications are typically to blame for rebound headache?
- Simple and combo analgesics
- Opiates
-Limit acute migraine therapy to fewer than 10 days a month**
Migraine patho
- neuropeptide release leads to dural blood vessel vasodilation
- neurogenic inflammation
- trigeminal pain fibers transmit pain
Long term goals of migraine treatment
- Reduce disability
- Improve quality of life
- Avoid escalation of headache medication use
Goals for acute migraine treatment
- 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
Analgesic (OTC) migraine therapy
- Acetaminophen
2. Acetaminophen + ASA + caffeine
NSAID (OTC) antiinflammatory drugs
- ASA
- Ibuprofen
- Naproxen
- Diclofenac
Triptans (examples and MOA)
- Sumatriptan (injection*, oral, nasal)
- Zolmitriptan (oral, nasal)
MOA: selective agonists of 5-HT
**First line for mild to severe migraine
Ergotamine Tartrate
- Oral with caffeine
- Rectal suppository with caffeine
- sublingual
-These are good for people who can’t take the triptans
Ergotamine MOA
- constrict intracranial blood vessels
- Central inhibition of the trigeminaovascular pathway
What are the 3 key actions of Triptans
- Normalize dilated intracranial arteries by stimulating vasoconstriction
- Inhibit vasoactive peptide
- Inhibit transmission through 2nd order neurons ascending to thalamus
What is important to remember about the sumatriptan (imitrex) nasal spray?
one spray in one nostril only
What should be considered as pretreatment with the ergotamines?
consider pretreatment with antiemetic
What do you need to keep in mind about the dihydroergotamine nasal spray?
discard open ampules after 8 hours
Adjunct Migraine therapies
- Metoclopramide (Reglan) [IV]: helpful for acute relief in office or ED. Improves bowel motility to help oral drugs reach small intestine faster
- Prochlorperazine (Compazine) [IV or IM]: helpful for acute relief in office or ED. Avoid in parkinson’s disease as this affects dopamine
Triptan ADE
"triptan sensations" -tightness, -pressure -heaviness -pain in chest -neck or -throat
Sumatriptan indications
- Migraine
2. Cluster
Migraine preventative therapy
- Propranolol**
- Timolol
- Divalproex sodium
- Topiramate
Trial for 2-3 months
What drug is taken in the perimenstrual period to prevent menstrual migraine?
Frovatriptan
-can also take Ibuprofen (motrin) for menstrual migraine prevention
What drug is helpful for migraine with aura and menstrual migraine?
Magnesium
side note: OCPs are contraindicated in migraine with aura
Prophylactic migraine therapies
- Magnesium
- MIG-99
- Riboflavin
- Melatonin
- Butterbur
Prophylactic managmment of migraine
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
Tension-Type Headache Tx
- Cognitive-Behavioral therapy (stress management, relaxation, training)
- Acetaminophen
- NSAIDs (Ibuprofen, ASA, Diclofenac, Naproxen)
Treatment length for tension type headache
- 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
Cluster headache: Tx
Abortive treatment:
- 100% O2
- Triptan (spray or injection, more effective than oral, except zolmitriptan)
- Ergotamines (IV)
Prophylaxis:
-Verapamil
