Headache Management Flashcards
Which medications are implicated in medication overuse headaches?
simple and combination analgesics and opiates
triptans (M w/ high frequency HA)
What is the recommendation for frequency of use of acute migraine therapies?
limit to < 10d/mo
Medication overuse headache: description
gradual onset of an atypical daily or near-daily headache with superimposed episodic migraine attacks
Migraine: description
recurring episodes of throbbing head pain
- unilateral
- 4-72hrs
- w/ N/V, sensitivity to light/sound/movement
What substance is implicated as an important mediator of migraine headaches?
5-HT (serotonin)
Migraines: acute migraine therapies
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
Ergot: MOA
nonselective 5 HT1 receptor agonist
venous and arterial constriction –> inhibits neurogenic inflammation
central inhibition of trigeminovascular pathway
Triptan: MOA
selective agonist of 5 HT1B and 5 HT1D receptors
- vasoconstriction
- inhibition of vasoactive peptides
- inhibition of transmission
What is first line therapy for patients with mild-severe migraines?
triptans
What drug interacts with rizatriptan?
propanolol (reduce dose of rizatriptan)
What is unique about frovatriptan, in relation to the other triptans?
most triptans can only be repeated once daily
frovatriptan can be taken 3x/d
What should be considered when prescribing ergotamine tartrate?
consider pretreatment with an antiemetic
Triptans: ADEs
triptan sensations:
- tightness
- pressure
- heaviness
- pain in chest/throat/neck
Sumatriptan: clinical applications
migraine HA
cluster HA
Which drug can precipitate serotonin syndrome?
sumatriptan