Headache meds

Question 1

Analgesics

Answer 1

Class: NSAIDs, COX2 inhibitor

Mech: Inhibition of COX

Thera: Acute treatment of moderate migraine (usually use excedrin (acetaminophen, aspirin, caffeine)
Acute treatment of tension headaches

Question 2

Barbiturates

Answer 2

Thera: Acute treatment of migraines (used only when more traditional therapies are unavailable or contraindicated,

Tox: Drowsiness, dizziness, risk of overuse, addiction, withdrawal

Misc: Use limited to 2-3 times per week

Question 3

Opioids

Answer 3

Thera: Acute treatment of migraines; patients with infrequent headaches; generally for patients who wake up with a headache.

Tox: Risk of overuse (addiction)

Misc: Use less than 2 days per week; pregnant women may use codeine or meperidine with caution.
May use in oral, IV, or transnasal form
May develop chronic daily headaches with overuse.

Question 4

Corticosteroids

Answer 4

Thera: Acute treatment of migraines; prolonged headache syndromes (chronic daily headache); rescue treatment for cluster headaches.

Misc: Chronic medication/overuse most common cause of chronic daily headaches
Enteral and paraenteral forms

Question 5

Ergotamine

Answer 5

Class: Ergot alkaloid

Mech: Vasoconstriction possibly (a1 agonist); may also act as a 5HT agonist in the trigeminal pathway

Thera: Acute treatment of migraines

Tox: Nausea, dizziness, paresthesias, chest pain, abdominal cramps

Misc: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; oral tablet, with caffeine, suppository

Question 6

Dihydroergotamine (DHE)

Answer 6

Mech: Vasoconstriction possibly (weaker than ergotamine); may also act as a 5HT agonist in the trigeminal pathway

Thera: Acute treatment of migraines; less likely to cause rebound headache than ergotamines; acute treatment of cluster headaches; short term prevention of cluster headaches along with steroids.

Tox: Nausea (Less than ergotamine), dizziness, chest pain, abdominal cramps

Misc: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; IM, IV, nasal spray; less effect on the uterus than ergotamine

Question 7

Sumatriptan

Answer 7

Class: Triptans

Mech: Selective 5HT1b,d agonists; penetration of CNS, constriction of extracerebral intracranial vessels, inhibition of trigeminovascular system

Thera: Acute treatment of migraines (premier option); also effective for photo/phonophobia, nausea, and vomiting; acute treatment of cluster headaches

Tox: Flushing, tingling, dizziness, chest discomfort (noncardiac)

Misc: Contraindicated in vascular disease, uncontrolled HTN, complicated migraine; injectable; no use during aura phase