Headache Disorders (Exam I Cut Off) Flashcards
1
Q
Primary Headaches
A
- 90-98% of cases, Benign
- Chronic recurrent pattern
- +/- lack of neurological findings
- Associated with morbidity
- EX: Migraine, tension headache, cluster headache, etc
2
Q
Secondary Headaches
A
- <10% of cases
- Due to underlying organic etiology
- Acute, progressive
- Present with physical and neurological findings
- Associated with mortality
- EX: head/neck trauma, cranial/cervical vascular disorder, nonvascular intracranial disorder, substance/withdrawal, infection, facial pain (structure related), psychiatric disorder
3
Q
Migraine Triggers
A
- Changes in hormone levels
- Altered sleep patterns
- Weather changes
- Psychological factors
- Sensory stimuli
- Alcohol and/or food
4
Q
Acute Migraine Treatment Goals
A
- Treat migraine attacks rapidly and consistently
- Restore person’s ability to function
- Minimize the use of backup and rescue medications
- Optimize self-care for overall management
- Be cost effective
- Minimal or no AE
5
Q
Long-term Migraine Treatment Goals
A
- Reduce migraine frequency, severity, and disability
- Reduce reliance on poorly tolerated, ineffective, or unwanted acute pharmacotherapies
- Improve QoL
- Prevent headache
- Avoid escalation of HA med use
- Educate/enable patients to manage their disease
- Reduce HA-related distress and psychological symptoms
6
Q
Migraine Nonpharm
A
- Rest/sleep in dark, quiet environments
- Ice/hot pack
- Headband-like device that stimulates branches of trigeminal nerve
7
Q
Mild Migraine Attack Treatments: Non-Rx
A
- APAP, ASA, NSAIDs
- Also combination products with caffeine
- Risk of GI ADRs and medication overuse HA
8
Q
Mild Migraine Attack Treatments: Rx
A
- Analgesics: NSAIDs
- 5HT Agonists (Triptans): alone or in combinations
- 5HT1F agonist
- Ergots
- CGRP Antagonist
- Butophanol spray, metoclopramide, prochlorperazine
9
Q
Triptans + Half-Lives
A
- Sumatriptan: 1.2-2.3 hr
- Naratriptan: 3-5 hr
- Frovatriptan: 2-4 hr
10
Q
Triptans
A
- MoA: vasoconstriction and reduction of neurogenic inflammation
- Combination of sumatriptan and naproxen available
11
Q
Triptan CI
A
- Ischemic coronary artery disease
- Coronary artery vasospasm
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled HTN
- Recent use of another 5HT agonist or ergot
- History of stroke or transient ischemic attack
- Co-administration with MAO-A Inhibitors (separate by 2 weeks)
12
Q
Triptan Patient Education
A
- First dose take as soon as possible when feeling migraine coming on
- Second dose taken at least 2 hours after initial dose (Naratriptan => 4 hours)
- Inform patients of maximum dose
13
Q
Ergot Pharmacology
A
- Partial alpha-adrenoreceptor/5HT agonists
- MoA: constriction of peripheral and cranial blood vessels
- PO, IV, and intranasal formulations available
- Metabolized by CYP3A4, CI with strong inhibitors of CYP3A4
14
Q
Ergot Warnings
A
- Cardiac valvular fibrosis
- Vasospasm or constriction
- Peripheral vascular ischemia and gangrene
- Pleural/retroperitoneal fibrosis
Associated with chronic use
15
Q
Ergot CI
A
- Hypersensitivity
- Peripheral vascular disease
- Hepatic or renal disease
- Coronary artery disease
- Hypertension
- Sepsis
- Pregnancy
