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Spring Pharm Block 2 > Headache > Flashcards

Headache Flashcards

1
Q

What are the signs and symptoms necessary to meet the diagnostic criteria for migraine headache?

A

At least 2 of POUND –> pulsatile, one-day duration, unilateral, nausea/vomiting, disabling intensity
At least 1 of –> nausea/vomiting, photophobia or phonophobia

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2
Q

Describe an aura as it relates to migraine headaches.

A

Positive symptoms (flashing lights, slots, lines) or negative symptoms (loss of vision, blind spot, numbness) that occur within 60 minutes of the headache’s onset

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3
Q

Describes the general pathophysiology associated with all headaches.

A

Long thought to have a vasodilatory component. But recently discovered to also be caused by a range of pro-inflammatory factors.

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4
Q

How is chronic tension headache disorder defined?

A

Headache at least 15 days per month

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5
Q

What are 4 risk factors for tension headache disorder?

A

Coexisting migraine disorder, depression, anxiety, poor stress management

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6
Q

Describe the typical clinical presentation of tension headache syndrome.

A

Dull, non-pulsatile tightness or pressure of mild to moderate severity that is usually bilateral

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7
Q

T/F: Migraine is the most severe headache disorder.

A

False: cluster headache disorder is most severe

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8
Q

Describe the clinical presentation of cluster headache disorder.

A

Unilateral, deep, excruciating non-pulsatile pain usually in or near the orbital region.

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9
Q

Describe the typical duration interval of cluster headache disorder.

A

Attacks occur daily for weeks or months followed by long (sometimes years) pain-free intervals

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10
Q

Describe the term secondary headache, list some common causes, and describe generally how they are treated.

A

Headache is a symptom of some other abnormality such as infection, stroke, tumor, hypertension, or hypoxia. The headache is resolved by treating the underlying cause.

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11
Q

Describe the concept of medication overuse headache.

A

Headache for 15+ days per month with regular overuse of headache drugs for 3+ months

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12
Q

What are the long term goals in management of a headache disorder?

A

Reduce frequency, severity, and disability
Prevent recurrence
Improve quality of life

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13
Q

What are the short term goals in management of a headache disorder?

A

Treat migraines rapidly and effectively
Minimize use of rescue meds
Cause minimal or no AEs

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14
Q

What medications are used to abort a headache once the symptoms have started?

A

APAP, NSAIDs, triptans, ergotamines, getants, ditan, opioids (rare)

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15
Q

What medications are used as prophylaxis for headache disorder and in what comorbid conditions might they ne most beneficial?

A

Predictable pattern: NSAIDs or triptans
HTN or angina: beta-blockers
Depression or insomnia: TCAs or SNRIs
Seizure or bipolar disorder: anticonvulsant or beta blockers if anticonvulsants ineffective

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16
Q

What medications are considered to be first line in prophylaxis for headache disorders?

A

Beta blockers

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17
Q

Which beta blocker is specifically approved for prophylactic use in headache disorder?

A

Propranolol

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18
Q

What is true about dosing of anticonvulsants in headache prophylaxis?

A

Used in lower doses than for seizure disorders

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19
Q

Describe the use of calcitonin gene-related peptide (CGRP) antagonists.

A

Block CGRP receptor just like getants do. But these medications are used for prophylaxis where getants are used to abort headaches.

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20
Q

Why are CGRP antagonists not commonly used in headache prophylaxis?

A

High cost

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21
Q

All four CGRP antagonist medications end in what suffix?

A

-umab

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22
Q

T/F: Some CGRP medications are available PO.

A

False: all are given by injection

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23
Q

In what patients would you not want to use a beta blocker as prophylaxis?

A

Asthma, COPD, bradycardia, AV nodal blocks

24
Q

What are the simple analgesic treatment options in the treatment of a headache?

A

APAP and NSAIDs

25
Q

Describe the mechanism of action of APAP and NSAIDs.

A

APAP: Inhibits synthesis of prostaglandins primarily in the CNS
NSAIDs: Inhibits synthesis of prostaglandins systemically by blocking COX-1 and COX-2

26
Q

What is the primary AE of APAP use?

A

Hepatotoxicity: monitor LFTs and avoid alcohol

27
Q

What are the primary AEs associated with NSAID use?

A

Dyspepsia, N/V, somnolence, dizziness

28
Q

What are the warnings/precautions to consider before prescribing NSAIDs?

A

Pregnancy, elderly, renal impairment, peptic ulcer disease, HTN, bleeding disorders

29
Q

When considering NSAIDs for headache disorders, what strategy is employed to avoid medication overuse disorder?

A

Limit NSAID use to fewer than 10 days per month

30
Q

What NSAIDs are commonly used in the treatment of headache disorder?

A

Aspirin, Ibuprofen, Naproxen, Diclofenac, Ketorolac

31
Q

What is unique about the use of ketorolac for headache use disorder?

A

Limit to use for no more than 5 consecutive days

32
Q

What are the three combination products used in the management of headache disorder

A

Excedrin: APAP, ASA, and caffeine
Fiorinal: ASA, caffeine, and butalbital
Fioricet: APAP, caffeine, and butalbital

33
Q

What is the mechanism of action of triptans?

A

Selective serotonin receptor agonists causing vasoconstriction and inhibition of vasoactive peptides

34
Q

Why are triptans not used as antidepressant medications?

A

There are many serotonin receptors. Triptans agonize two specific receptors that are not related to depression.

35
Q

What are the AEs associated with triptans?

A

Chest pain, somnolence, dizziness, flushing

36
Q

What drug interactions are associated with use of triptans?

A

Do not use within 24 hours of ergotamines
Do not use within 2 weeks of MAOIs
Caution with serotonergic agents (SSRIs, SNRIs, tramadol, linezolid, ondansetron)

37
Q

What are the warnings/precautions to consider before prescribing triptans?

A 
Contraindicated in coronary artery disease
Uncontrolled HTN
Cerebrovascular disease
Hemiplegic and basilar migraines
Postmenopausal women and men > 40
38
Q

When is the best time to take a triptan medication?

A

At the onset of pain

39
Q

T/F: All triptans have roughly the same efficacy in all patients.

A

False: patients may respond to some triptans but not others

40
Q

T/F: Adding an NSAID or APAP to a triptan has greater efficacy for headache disorders.

A

True: triptans work better than NSAIDs or APAP alone. But adding either to use of a triptan increases efficacy

41
Q

Which triptans may be used if the patient has severe nausea or vomiting associated with their headache and why?

A

Sumatriptan: can be given nasally or SubQ

Zolmitriptan or Rizatriptan: can be given as an orally dissolving tablet

42
Q

What is the mechanism of action of ergotamine medications?

A

Non-selective serotonin agonist that causes vasoconstriction and blocks inflammation

43
Q

What are the common AEs associated with ergotamine medications?

A

Abdominal pain, muscle pain, N/V (most common), weakness, fatigue, chest tightness

44
Q

What is the black box warning for ergotamine medications?

A

Severe peripheral ischemia –> cold/numb extremities, peripheral paresthesia, diminished peripheral pulses

45
Q

What drug interactions are associated with use of ergotamine medications?

A

Do not use within 24 hours of triptans

46
Q

What are the warnings/precautions to consider before prescribing ergotamine medications?

A

Hepatic/renal failure, sepsis, vascular disease, uncontrolled HTN, pregnant or nursing women

47
Q

What are two key considerations when prescribing an ergotamine?

A

High risk of rebound headache and pretreat with an antiemetic

48
Q

What is the mechanism of action of getants?

A

Calcitonin gene related peptide receptor antagonist

49
Q

What are the AEs associated with use of getants?

A

Drowsiness, nausea, xerostomia

50
Q

T/F: The getants have a lot of drug interactions.

A

True: inhibits CP-450 enzymes

51
Q

What are the warnings/precautions to consider before prescribing getants?

A

Hepatic or renal impairment

52
Q

Why are getants not commonly used in headache disorders?

A

Cost

53
Q

What is the mechanism of action of ditan?

A

Selective serotonin receptor agonist that treats pain without vasoconstriction

54
Q

What are the AEs associated with use of ditan?

A

Dizziness, N/V, chest discomfort, palpitations

55
Q

What drug interactions are associated with ditan use?

A

Other serotonergic agents

56
Q

What are the warnings/precautions to consider before prescribing ditan?

A

Hepatic or renal impairment and the elderly

57
Q

Why is ditan not commonly used in headache disorders?

A

Cannot drive or operate machinery for 8 hours after ingestion

Spring Pharm Block 2 (7 decks)

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