Headache Management Flashcards

1
Q

Which medications are implicated in medication overuse headaches?

A

simple and combination analgesics and opiates

triptans (M w/ high frequency HA)

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2
Q

What is the recommendation for frequency of use of acute migraine therapies?

A

limit to < 10d/mo

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3
Q

Medication overuse headache: description

A

gradual onset of an atypical daily or near-daily headache with superimposed episodic migraine attacks

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4
Q

Migraine: description

A

recurring episodes of throbbing head pain

  • unilateral
  • 4-72hrs
  • w/ N/V, sensitivity to light/sound/movement
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5
Q

What substance is implicated as an important mediator of migraine headaches?

A

5-HT (serotonin)

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6
Q

Migraines: acute migraine therapies

A

analgesics (acetaminophen, excedrin migraine)

NSAIDs (ASA, IBU, naproxen sodium, diclofenac)

serotonin agonists (triptans: sumatriptan, zolmitriptan)

adjunctive therapies:

  • metoclopramide (prokinetic, antiemetic)
  • prochlorperazine (antiemetic)

older:

  • ergotamine tartrate
  • dihydroergotamine
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7
Q

Ergot: MOA

A

nonselective 5 HT1 receptor agonist

venous and arterial constriction –> inhibits neurogenic inflammation

central inhibition of trigeminovascular pathway

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8
Q

Triptan: MOA

A

selective agonist of 5 HT1B and 5 HT1D receptors

  • vasoconstriction
  • inhibition of vasoactive peptides
  • inhibition of transmission
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9
Q

What is first line therapy for patients with mild-severe migraines?

A

triptans

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10
Q

What drug interacts with rizatriptan?

A

propanolol (reduce dose of rizatriptan)

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11
Q

What is unique about frovatriptan, in relation to the other triptans?

A

most triptans can only be repeated once daily

frovatriptan can be taken 3x/d

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12
Q

What should be considered when prescribing ergotamine tartrate?

A

consider pretreatment with an antiemetic

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13
Q

Triptans: ADEs

A

triptan sensations:

  • tightness
  • pressure
  • heaviness
  • pain in chest/throat/neck
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14
Q

Sumatriptan: clinical applications

A

migraine HA

cluster HA

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15
Q

Which drug can precipitate serotonin syndrome?

A

sumatriptan

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16
Q

Serotonin Syndrome: clinical presentation

A
hyperthermia
hyperreflexia
tremor
clonus
hypertension
hyperactive bowel sounds
diarrhea
mydriasis
agitation
coma
17
Q

Serotonin Syndrome: treatment

A
discontinue precipitating drugs
sedation (benzodiazepines)
paralysis
intubation
ventilation
18
Q

Serotonin Syndrome: look alikes

A

neuroleptic malignant syndrome (longer onset, acute sev parkinsonism)

malignant hyperthermia (quicker onset, muscle rigidity, tachycardia)

19
Q

What is the first line treatment for migraine prophylaxis?

A

propranolol

20
Q

Migraine: indications for preventative therapy

A

> 2 attacks/wk

sx therapies are ineffective/contraindicated/cause serious ADEs

21
Q

Migraine: preventative therapy: agents

A
propranolol
timolol
divalproex sodium (valproic acid)
topiramate
CGRP monoclonal antibodies (erenumab, galcanezumab)
22
Q

When do you see maximal benefits of preventative therapy in migraines?

A

6 months

23
Q

CGRP monoclonal antibodies:

  • effects
  • agents
  • benefits
  • ADEs
A

dec migraine frequency

erenumab, galcanezumab

reduce CNS ADEs
long half lives

ADEs:

  • form neutralizing antibodies
  • constipation
  • muscle cramps/spasms
24
Q

Prophylactic Migraine Therapies

A

metoprolol
propranolol
timolol

topiramate
valproic acid/divalproex sodium

ibuprofen (menstrual migraines)
ketoprofen
naproxen sodium

25
Q

Frovatriptan: prophylactic special instructions

A

take in perimenstrual period to prevent menstrual migraines

26
Q

Supplemental Prophylactic Migraine Therapies

A
magnesium
feverfew
riboflavin
melatonin
butterbur
27
Q

you need to know

A

slide 42

28
Q

Tension Type Headache: treatment options

A

CBT (stress management, relaxation training, biofeedback)

simple analgesics (+/- caffeine)(acetaminophen)

NSAIDs (ASA, diclofenac, IBU, naproxen, ketoprofren, ketorolac)

29
Q

Effective options in tension type headaches

A

high dose NSAID

+ (ASA or APAP) w/ butalbital or codeine

30
Q

Tension Type Headaches: limit on acute medications

A

butalbital containing: 3d

combination analgesics: 9d

NSAIDs: 15d

(per month)

31
Q

There is no evidence to support the efficacy of _________ in the management of episodic tension type headaches.

A

muscle relaxants

32
Q

Tension Type Headaches: preventative therapy

A
TCAs
SSRIs (not effective unless they have depression)
SNRIs?
topiramate, gabapentin?
botulinum toxin?
33
Q

Cluster Headache: description

A

excruciating unilateral head pain

lasts wks or months separated by remission periods lasting months or years

accompanied by cranial autonomic sx

hallmark: circadian rhythm of painful attacks

34
Q

Cluster Headache: abortive therapy

A

oxygen (100% by non rebreather facial mask)

triptans (sprays or injections)

ergotamine derivatives (IV dihydroergotamine or ergotamine tartrate)

35
Q

Cluster Headache: prophylactic therapy

A

verapamil
lithium (monitor thyroid and renal function)
corticosteroids

36
Q

What is the preferred 1st line treatment for prevention of cluster headaches?

A

verapamil

37
Q

Sumatriptan: ADEs

A

paresthesias
dizziness
chest pain
possible coronary vasospasm