Headache - Hon

Question 1

Aura

Answer 1

Flashes of light or transient blind spots (scintillations or scotomas)

Question 2

MODERATE to SEVERE Aggravated by activity Inhibits/prohibits daily activity LATE 30s, FEMALE 1-4 attacks per month 12-24 hr duration UNILATERAL (usually) THROBBING/SHARP RETREATS to DARK QUIET ROOM No aura

Answer 2

Common migraine

Question 3

Most common symptoms in migraine

Answer 3

Nausea Vomiting Photophobia Phonophobia

Question 4

15-30 min aura prior to headache (flashes of light, blind spots, other neurologic symptoms)

Answer 4

Classic migraine

Question 5

MILD to MODERATE Does NOT prohibit activity No prodrome or aura Several hours in duration Less than 15 days per month Frontal and occipital regions (“BAND”) Dull, aching, squeezing

Answer 5

Episodic Tension-Type Headache

Question 6

MILD to MODERATE Does NOT prohibit activity No prodrome or aura ALL DAY ON and OFF More than 15 days per month Frontal and occipital regions (“BAND”) Dull, aching, squeezing Cause?

Answer 6

Chronic Tension-Type Headache Rebound from chronic pain killer usage

Question 7

Inhibiting/Prohibiting activity Moderate to Severe Sharp, throbbing 15 or more days per month 4 hours or longer 3 months straight No other cause

Answer 7

Chronic migraine

Question 8

Excruciating pain Prohibits daily activity MALE Sleep disturbances 30 min to 2 hours 1 or more per day for 6-8 weeks Commonly same time of year ORBITOTEMPORAL, U/L “Ice pick through eye” Frenetic, pacing, rocking Autonomic symptoms

Answer 8

Episodic cluster headaches

Question 9

Excruciating pain Prohibits daily activity MALE Sleep disturbances 30 min to 2 hours Several per week, never full remission ORBITOTEMPORAL, U/L “Ice pick through eye” Frenetic, pacing, rocking Autonomic symptoms

Answer 9

Chronic cluster headaches

Question 10

Acute treatment of migraines

Answer 10

OTC analgesics NSAIDs Isometheptene Butalbital Opiods (codeine, morphine, oxy, hydrocodone) DHE nasal spray Triptans (serotonin agonists)

Question 11

Contraindications to Triptan usage

Answer 11

Ischemic heart disease, vascular disease, HTN, Raynaud’s, renal/hepatic impairment, MAOIs, OTHER SEROTONIN AGONISTS

Question 12

If one Triptan doesn’t work, do what?

Answer 12

Try another

Question 13

If oral drugs don’t work, do what?

Answer 13

DHE nasal spray, or Sumatriptan injectable

Question 14

Contraindications for DHE spray?

Answer 14

SAME AS TRIPTANs

Question 15

When to consider preventative migraine treatments?

Answer 15

One or more HAs per week

Question 16

Preventative treatments for migraines

Answer 16

Antidepressants (Tri-cyclic, SSRIs, MAOIs) Beta blockers Ca++ channel blockers Anticonvulsants Ergot alkaloids NSAIDs Muscle relaxants

Question 17

Patient is being preventatively treated for migraines, but develops retroperitoneal fibrosis. Most likely drug?

Answer 17

Methysergide (Sansert)

Question 18

Common SSRIs

Answer 18

Prozac, Zoloft, Paxil, Duloxetine

Question 19

BOTOX

Answer 19

Only FDA-approved Tx for chronic migraines

Question 20

Non-Rx Tx of migraine

Answer 20

Exercise, stop smoking, education, vitamins, relaxation/stress management

Question 21

Acute Tx of tension-type headaches

Answer 21

OTC analgesics

NSAIDs

Opioids

Isometheptene

Question 22

Prevention Tx of tension-type headaches

Answer 22

Antidepressants (same as before)

Muscle relaxants

Anticonvulsants

BOTOX

Alkaloids

Question 23

Acute Tx of Cluster headaches

Answer 23

DHE

Lidocaine

Narcotics (morphine, meperdine)

Oxygen by mask

Supatriptan IV

Question 24

Preventative Tx for cluster headaches

Answer 24

Calcium channel blocker

Anticonvulsant

Lithium

Indomethacin

Prednisone taper

Capsaicin intranasal