Headache Disorders Flashcards
First line therapy for migraines involves either a Step-therapy or a Stratified therapy. Step therapy involves
- Treat with NSAIDs or combo (with an opiate or narcotic)
2. switch to a migraine specific agent if no response to NSAIDs
Stratified therapy involves
Going straight to migraine specific agents in severe migraine
Non-Specific migraine treatment (4 things)
- NSAIDs
- Analgesics
- Antiemetics
- Corticosteroids
Migraine-specific treatment (2 things)
- Ergot derivatives
- 5-HT1B/ID agonists
This class of drugs are first line for mild to moderate migraines
NSAIDS
This class of drugs is reserved for severe migraine if HA is unresponsive to other treatments
Opiods
This drug is a synthetic narcotic antagonist-agonist used for severe migraine. It is a nasal spray
Butorphanol
This drug causes a depressant effect on the CNS
Butalbital
This class of drugs is used for non-specific migraine treatment in combination w/ analgesics or codeine
Barbiturate combinations (hypnotics)
This class of drugs act as 5-HT1 agonist, activity of alpha, beta-adrenergic receptors and DA receptors
Ergot alkaloids
Name two types of ergot alkaloids
Ergotamine tartrate (rectal, PO, SL) Dihydroergotamine (inj, nasal spray)
Acute side effects include N/V (surely), diarrhea, abdominal pain, weakness, leg cramps, tremor, dizziness, syncope
Ergotamine
Acute side effects include chest pain, intermittent claudication, and syndrome ergotism
Ergotamine
name the syndrome: peripheral ischemia, cold/numb extremities, diminished peripheral pulses
syndrome of ergotism
Chronic side effects include: cerebral/peripheral ischemic disorders, HTN, tachy/brady, medication overuse HA, renal D/O, and withdrawal signs
Ergotamine
Contraindications include use of triptans within 24 hours
Ergotamine
This drug is a CYP 3A4 substrate that has interactions with strong 3A4 inhibitors, triptans, and Fluoxetine, fluvoxamine
Ergotamine
These drugs are selective 5-HT 1B/1D agonists
triptans
These drugs are first line for moderate to severe migraine
triptans
Triptan available as SQ injection, oral tabs, and nasal spray
Sumitriptan
Triptan available in oral tabs and oral disintegrating tabs
Rizatriptan
Triptan available as oral tabs, oral disintegrating tabs, and nasal spray
Zolmitriptan
Side effects include dizziness, fatigue, flushing, nausea, chest tightness/pain/pressure, injection reaction, and taste perversion from spray
Triptans
Contraindications include: Ergot alkaloid in last 24 hours, MAOI in last 2 weeks, uncontrolled HTN, ischemic heart disease, basilar/hemiplegic migraine
Triptans
Interaction of triptan with these 2 classes of drugs increases risk of serotonin syndrome
MAOI, SSRI
Results in hypothermia, muscle rigidity, myoclonus, rapid change in mental status and vitals
serotonin syndrome
1st line agents for prophylactic migraine treatment
beta blockers
tricyclic antidepressants
ADRs include fatigue, vivid dreams, depression, impotence, bradycardia, hypotension
beta blockers
Antagonist of 5-HT2 receptors inhibiting the reuptake of serotonin and causing an increased concentration of serotonin at the synaptic cleft
TCAs
ADRs include sedation, constipation, blurred vision, and hypotension
TCAs
Name 4 other drugs/classes that can be used as prophylactic migraine treatment
Anticonvulsants
Calcium channel blockers
Methysergide
Botulinum toxin type A
These drugs increase the availability of GABA- inhibitory neurotransmitter
anticonvulsants
Dont use these prophylactic migraine drugs if the patient has liver disease
anticonvulsants
ADRs include tremor, weight gain, nausea, hair loss
anticonvulsants
These are vasodilators that cause decrease in smooth muscle tone and vascular resistance
calcium channel blockers
This drug is a peripheral 5-HT inhibitor but a central 5-HT agonist
Methysergide
can cause fatal pulmonary fibrosis
Methysergide
inhibits Ach release at the presynaptic cholinergic junction
Botulinum toxin type A
Natural products for migraine therapy include
caffeine (acute therapy)
butterbur (prevention)
coenzyme q10
feverfew
How do you treat an intractable migraine?
DHE Sumitriptan Prochlorperazine/chlorpromazine Narcotics Corticosteroids
How do you treat tension type headache acutely?
Analgesics (APAP, ASA, Ibu, naproxen)
Sedatives (butalbital)
How do you treat tension type headache prophylactically?
TCAs
Muscle relaxants
Botulinum toxin
How do you treat cluster HA acutely?
Imitrex O2 inhalation Ergotamine DHE-45 Lidocaine
How do you treat cluster HA prophylactically?
Verapamil Prednisone Ergotamine Methysergide Litium
