Headache Disorders

Question 1

First line therapy for migraines involves either a Step-therapy or a Stratified therapy. Step therapy involves

Answer 1

1. Treat with NSAIDs or combo (with an opiate or narcotic)

2. switch to a migraine specific agent if no response to NSAIDs

Question 2

Stratified therapy involves

Answer 2

Going straight to migraine specific agents in severe migraine

Question 3

Non-Specific migraine treatment (4 things)

Answer 3

• NSAIDs
• Analgesics
• Antiemetics
• Corticosteroids

Question 4

Migraine-specific treatment (2 things)

Answer 4

• Ergot derivatives

- 5-HT1B/ID agonists

Question 5

This class of drugs are first line for mild to moderate migraines

Answer 5

NSAIDS

Question 6

This class of drugs is reserved for severe migraine if HA is unresponsive to other treatments

Answer 6

Opiods

Question 7

This drug is a synthetic narcotic antagonist-agonist used for severe migraine. It is a nasal spray

Answer 7

Butorphanol

Question 8

This drug causes a depressant effect on the CNS

Answer 8

Butalbital

Question 9

This class of drugs is used for non-specific migraine treatment in combination w/ analgesics or codeine

Answer 9

Barbiturate combinations (hypnotics)

Question 10

This class of drugs act as 5-HT1 agonist, activity of alpha, beta-adrenergic receptors and DA receptors

Answer 10

Ergot alkaloids

Question 11

Name two types of ergot alkaloids

Answer 11

Ergotamine tartrate (rectal, PO, SL)
Dihydroergotamine (inj, nasal spray)

Question 12

Acute side effects include N/V (surely), diarrhea, abdominal pain, weakness, leg cramps, tremor, dizziness, syncope

Answer 12

Ergotamine

Question 13

Acute side effects include chest pain, intermittent claudication, and syndrome ergotism

Answer 13

Ergotamine

Question 14

name the syndrome: peripheral ischemia, cold/numb extremities, diminished peripheral pulses

Answer 14

syndrome of ergotism

Question 15

Chronic side effects include: cerebral/peripheral ischemic disorders, HTN, tachy/brady, medication overuse HA, renal D/O, and withdrawal signs

Answer 15

Ergotamine

Question 16

Contraindications include use of triptans within 24 hours

Answer 16

Ergotamine

Question 17

This drug is a CYP 3A4 substrate that has interactions with strong 3A4 inhibitors, triptans, and Fluoxetine, fluvoxamine

Answer 17

Ergotamine

Question 18

These drugs are selective 5-HT 1B/1D agonists

Answer 18

triptans

Question 19

These drugs are first line for moderate to severe migraine

Answer 19

triptans

Question 20

Triptan available as SQ injection, oral tabs, and nasal spray

Answer 20

Sumitriptan

Question 21

Triptan available in oral tabs and oral disintegrating tabs

Answer 21

Rizatriptan

Question 22

Triptan available as oral tabs, oral disintegrating tabs, and nasal spray

Answer 22

Zolmitriptan

Question 23

Side effects include dizziness, fatigue, flushing, nausea, chest tightness/pain/pressure, injection reaction, and taste perversion from spray

Answer 23

Triptans

Question 24

Contraindications include: Ergot alkaloid in last 24 hours, MAOI in last 2 weeks, uncontrolled HTN, ischemic heart disease, basilar/hemiplegic migraine

Answer 24

Triptans

Question 25

Interaction of triptan with these 2 classes of drugs increases risk of serotonin syndrome

Answer 25

MAOI, SSRI

Question 26

Results in hypothermia, muscle rigidity, myoclonus, rapid change in mental status and vitals

Answer 26

serotonin syndrome

Question 27

1st line agents for prophylactic migraine treatment

Answer 27

beta blockers | tricyclic antidepressants

Question 28

ADRs include fatigue, vivid dreams, depression, impotence, bradycardia, hypotension

Answer 28

beta blockers

Question 29

Antagonist of 5-HT2 receptors inhibiting the reuptake of serotonin and causing an increased concentration of serotonin at the synaptic cleft

Answer 29

TCAs

Question 30

ADRs include sedation, constipation, blurred vision, and hypotension

Answer 30

TCAs

Question 31

Name 4 other drugs/classes that can be used as prophylactic migraine treatment

Answer 31

Anticonvulsants Calcium channel blockers Methysergide Botulinum toxin type A

Question 32

These drugs increase the availability of GABA- inhibitory neurotransmitter

Answer 32

anticonvulsants

Question 33

Dont use these prophylactic migraine drugs if the patient has liver disease

Answer 33

anticonvulsants

Question 34

ADRs include tremor, weight gain, nausea, hair loss

Answer 34

anticonvulsants

Question 35

These are vasodilators that cause decrease in smooth muscle tone and vascular resistance

Answer 35

calcium channel blockers

Question 36

This drug is a peripheral 5-HT inhibitor but a central 5-HT agonist

Answer 36

Methysergide

Question 37

can cause fatal pulmonary fibrosis

Answer 37

Methysergide

Question 38

inhibits Ach release at the presynaptic cholinergic junction

Answer 38

Botulinum toxin type A

Question 39

Natural products for migraine therapy include

Answer 39

caffeine (acute therapy) butterbur (prevention) coenzyme q10 feverfew

Question 40

How do you treat an intractable migraine?

Answer 40

``` DHE Sumitriptan Prochlorperazine/chlorpromazine Narcotics Corticosteroids ```

Question 41

How do you treat tension type headache acutely?

Answer 41

Analgesics (APAP, ASA, Ibu, naproxen) | Sedatives (butalbital)

Question 42

How do you treat tension type headache prophylactically?

Answer 42

TCAs Muscle relaxants Botulinum toxin

Question 43

How do you treat cluster HA acutely?

Answer 43

``` Imitrex O2 inhalation Ergotamine DHE-45 Lidocaine ```

Question 44

How do you treat cluster HA prophylactically?

Answer 44

``` Verapamil Prednisone Ergotamine Methysergide Litium ```