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OMS - 2 Neuro Final > Headache & Facial Pain > Flashcards

Headache & Facial Pain Flashcards

1
Q

Calcitonin gene-related peptide (CGRP) antagonist: pathways

A
  1. These receptors occur at all Sites involved in migraine pathogenesis as well as vasodilation
  2. Locations: DRG, CN V & X gnaglia, dorsal horn, trigeminal nucleus caudallis, nucleus of the solitary tract, brainstem, amygdala, hypothalamus, hypothalamic nuclei, dorsal insular cortex
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2
Q

GCRP’s actions (6)

(calcitonin gene-related peptides)

A
  1. Vasodilation
  2. Mast cell degranulation
  3. Dural inflammation
  4. Peripheral sensitization
  5. Pain transmission
  6. Central sensitization
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3
Q

______ is released into the jugular venous system during migraine which in turn evokes the migraine.

A

CGRP’s (calcitonin gene-related peptides)

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4
Q

Antibodies to CGRP or its receptor prevents migraine by _______ (2)

A
  1. Removing excess CGRPs released from the trigeminal nerve endings
  2. Receptor antibodies blocks the receptor from signaling transmission
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5
Q

Anti-CGRP monoclonal Antibodies have ______% responder rate.

A

75

(rapid onset, good tolerance & safety, no neutralizing antibodies detected)

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6
Q

Go-to medication for migraine?

A

Anti-CGRP monoclonal antibodies

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7
Q

Short term side effects of anti-CGRP monoclonal antibodies (4)

A
  1. URI
  2. nausea
  3. hyper-sensitivity rxn
  4. constipation
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8
Q

Potential long-term side effects from anti-CGRP monoclonal antibodies (4)

A
  1. pituitary dysfxn
  2. cardiovascular (ischemia, HTN)
  3. GI (ulcer, IBS)
  4. Skin (infalammation, wound healing)
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9
Q

Botox MOA

A
  1. Produces sensory input to CNS
  2. Reduces input to muscle spindle
  • Decreases Nocioceptor Pathways
  • C and A delta fibers
  • Substance P
  • CGRP
  • Glutamate release
  • Mechano- and Chemo-receptors
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10
Q

Botox has been approved for chronic migraine by the FDA if _____ (2).

A
  1. Greater than 15 headaches per month (have them keep a headache calendar)
  2. Failed two classes of prophylactic medications
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11
Q

Botox includes _____ injections each treatment, over _____weeks.

A
  • 30 to 40
  • 12

(Cost 300 to $600 for treatment)

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12
Q

Which drugs have level A (evidence-base medicine grade - more than 1 class 1 trial) (5)?

A
  1. Anti-CGRP mAb (MC used)
  2. Antiepileptic
  3. Beta blockers
  4. Botulinum toxin A
  5. Triptans
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13
Q

Define status migrainosus (2)

A
  • Migraine that lasts over 72 hours
  • Refractory to Conventional treatment
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14
Q

Status migrainosus treatment (4)

A
  1. Steroid burst (dexamethasone or prednisone)
  2. Headache cocktail (3 different cocktails)
  3. IV valproate
  4. DHE-DiHydroErgotamine (last resort: must be admitted, Neurologist handles this)

(DO NOT give opioids)

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15
Q

Headache cocktails for status migrainosis (3)

A
  1. Ketorolac, Diphenhydramine, Prochlorperazine
  2. Metoclopramide, Benadryl, Ibuprofen
  3. DHE Nasal spray, prochlorperazine (DHE- must admit & call neurologist)
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16
Q

Emergency room treatment for status migrainosus (5)

A
  1. IV normal saline (if they’ve been vomiting/diahrrea)
  2. Diphenhydramine
  3. Metoclopramide
  4. Magnesium Sulfate
  5. Ketoralac

(all via IV. If no response: Valproate, Levetiracetam, Methylprednisolone, Dihydroergotamine)

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17
Q

Behavioral treatments for headache (5)

A
  1. Relaxation training
  2. Hypnotherapy
  3. EMG or thermal Biofeedback
  4. Cognitive behavioral therapy
  5. RELAXaHEAD app
18
Q

Physical Treatments for headache (6)

A
  1. Acupuncture
  2. Heat
  3. TENS
  4. Occlusal adjustment (TMJ)
  5. OMM
  6. Yoga
19
Q

Over-the-counter supplements for headaches (9)

A
  1. Magnesium
  2. Riboflavin
  3. Melatonin
  4. CoQ10
  5. Butterbur
  6. Feverfew
  7. Petadolex
  8. Topical Menthol
  9. Neti Pot (if congested and pain over sinuses)
20
Q

Lifestyle modifications for headaches (6)

A
  1. Diet
  2. Environment
  3. Exercise
  4. Sleep
  5. Stress Management
  6. Tobacco cessation
21
Q

FDA approved devices to treat headaches (3)

A
  1. TENS (prevention & acute)
  2. GammaCore - Vagus N. Stim
  3. Transcranial Magnetic Stimulation (SpringTMS)
22
Q

TENS unit for migraine? How does it work?

A
  • Cefaly device
  • Targets trigeminal nucleus caudal: slows modulation of cortical areas
23
Q

What is the only FDA approved treatment for cluster?

A

VNS device: gammaCore

(mostly used in headache clinics)

24
Q

How long does a cluster headache last?

(suicide headache)

A

15-180 minutes

25
Q

Cluster headache sx (4)

(suicide headache)

A
  1. lacrimation
  2. forehead, facial sweating
  3. mitosis and/or ptosis
  4. restlessness or agitation
26
Q

MC trigger for cluster headache/suicide headache

A

alcohol

27
Q

Best treatment for cluster/suicide headache?

A

oxygen by face mask

28
Q

cluster headache pain location (3)

A
  1. unilateral orbital
  2. supraorbital
  3. temporal
29
Q

Tx for cluster headache (3)

(other than O2)

A
  1. Sumatriptan
  2. Zolmitriptan
  3. VNS
  4. Sub-occipital steroid injections
30
Q

Medication over-use headache duration

A

15 days/month

31
Q

Medication over-use headache criteria

A
  1. overuse for >3 months of one or more drugs
  2. headache occurring on 15 days/month

(not better accounted for by another dx)

32
Q

medication overuse headache typically occurs in which patient population?

A

migraine & cluster/suicide headache patients

33
Q

Medication/overuse headache tx (4)

A
  1. steroids
  2. ketorolac
  3. tizanidine
  4. DHE

(40% relapse)

34
Q

Pregnant patients: how many have headaches?

A

30%

35
Q

2 MC types of headache in pregnant patients?

A
  1. Migraine w/o aura 64%
  2. Tension 26%
36
Q

Causes of migraine in pregnant patients (6)

A
  1. hormones
  2. sleep difficulty
  3. low blood glucose
  4. dehydration
  5. nasal congetion
  6. caffeine/sugar withdrawal
37
Q

Non-pharmacologic tx for migraine in pregnant patients (6)

A
    1. cold compress
  2. warm bath
  3. massage, acupuncture, OMM
  4. cefaly
  5. hyperbaric O2
38
Q

Migraine in pregnancy rx (4)

A
  1. acetaminophen
  2. metoclopramide
  3. prednisone (category B)
  4. Triptans (category C)
39
Q

Opioid analgesics that are Category B; safe for pregnancy (3)

A
  1. codeine
  2. oxycodein
  3. meperidone
40
Q

Prophylactic treatment for disabling migraine attacks in pregnant patients (4)

A
  1. Beta blockers
  2. magnesium
  3. riboflavin
  4. fluoxetine
41
Q

Rx that must be avoided in pregnancy (6)

A
  1. barbituates
  2. benzos
  3. ergotamine or DHE
  4. butterbur
  5. feverfew
  6. Co-Q10

OMS - 2 Neuro Final (36 decks)

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