Headache management Flashcards
What is a Medication-overuse Headache/Rebound Headache
How does this happen?
The frequent or excessive use of acute migraine medications
headache returns as the medication wears off, leading to the consumption of more drug for relief.
How can you prevent rebound headaches?
Limit the use of acute migraine therapies to fewer than 10 days per month
What are symptoms associated with Migraine headaches
Frequently unilateral
untreated can last from 4 to 72 hours
nausea, vomiting
sensitivity to light, sound, and/or movement
What is an important part of the pathophysiology that cause migraines?
Activation of trigeminal sensory nerves triggers the release of vasoactive neuropeptides
What drugs fall under Analgesic class
Acetaminophen (Tylenol)
Acetaminophen 250 mg/aspirin 250 mg/caffeine 65 mg (Excedrin Migraine)
What drugs fall under NSAIDS
Aspirin
Ibuprofen (Motrin)
Naproxen sodium (Aleve, Anaprox)
Diclofenac (Cataflam, Voltaren)
What drugs fall under Serotonin Agonists (Triptans)
Sumatriptan
Zolmitriptan
What do Non-selective 5-HT1 receptor agonists do?
Constrict intracranial blood vessels and inhibit the development of neurogenic inflammation in the trigeminovascular system
MOA of Triptans?
Selective agonists of the 5-HT1B and 5-HT1D receptors
Result of three key actions:
- normalization of dilated intracranial arteries through enhanced vasoconstriction
- inhibition of vasoactive peptide release from perivascular trigeminal neurons
- inhibition of transmission through second-order neurons ascending to the thalamus
What is the maximum dosage of oral Sumatriptan?
200 mg max dosage
What should you avoid with oral and nasal Zolmitriptan?
Do not divide the two forms
When taking Ergotamine what should you take with it?
consider pretreatment with an antiemetic
What are Metoclopramide useful for Prochlorperazine
Useful for adjunct therapy relief in the office or emergency department setting
Also is an anti-emetic
What is an Adverse event when taking Triptan
“Triptan sensations”
Chest tightness,
pressure,
heaviness, or
pain in the chest, neck, or throat
What can Sumatriptan be used for to treat?
Migraine AND cluster headache
ADE of Sumatriptan?
Paresthesias, dizziness, chest pain
• possible coronary vasospasm
How do you treat Serotonin syndrome caused by Triptan drugs?
Sedation (benzodiazepines)
Paralysis
Intubation and ventilation
How do you treat Neuroleptic malignant syndrome
Diphenhydramine (parenteral),
cooling if temperature is very high
How do you treat Malignant hyperthermia
Dantrolene, cooling
What medications can be used as preventative therapy for migraines
Propranolol
Timolol
Divalproex sodium
Topiramate
What migraine med can be used intermittently, such as for menstrual migraine prevention
Ibuprofen
What migraine med can be taken in the perimenstrual period to prevent menstrual migraine
Frovatriptan
MC type of headache?
Tension type headache- pain is like a band squeezing the head
1st line treatment for Tension Headaches?
What is another alternative
Simple analgesics - Acetaminophen
NSAIDS
When treating Tension headaches, butalbital-containing meds should be taken no more than how many times per month
3 days
When treating Tension headaches, combination analgesics meds should be taken no more than how many times per month
9 days
When treating Tension headaches, NSAIDS should be taken no more than how many times per month
15 days
What meds can be used for preventative therapy for Tension type headaches
TCAs (tricyclic antidepressants)
SSRIs (Selective Serotonin Reuptake Inhibitors) –> only effective in patients who also have depression
What is not recommended for preventative therapy for Tension HA?
Botulinium toxin
What are cluster headaches and how are they described?
Headache around the eye
Excruciating, unilateral head pain that occur in series lasting for weeks or months
What is a hallmark finding of Cluster HA?
circadian rhythm of painful attacks.
What is the standard of treatment for Cluster HA?
Abortive Therapy
Inhalation of 100% oxygen by nonbreather facial mask
Triptans sprays or injections
Ergotamine Derivatives –> Clinically IV dihydroergotamine , or ergotamine tartrate
What is 1st line PROPHYLACTIC treatment of Cluster HA
Verapamil
