Headache Meds Flashcards
3 primary headaches (see the chart on slide 5)
Migraine headache, tension headache, cluster headache (there’s an “other” category too)
Secondary headaches are attributed to:
Head/neck trauma, cranial/cervical vascular disorders, infection, psych disorders
Acetaminophen
Acts centrally
Possible 1st choice in acute migraine for those with mild/moderate attacks or CIs to NSAIDs/ASA
Butalbital in Fioricet and Fiorinal
Limited efficacy, abuse potential, withdrawal, med overuse
Prob won’t use this
Midrin C-IV (ASA, isometheptene, dichloralphenzone)
Alternative for mild/moderate migraine (Iso = vasoconstriction, dichlor = analgesic/sedative)
Excedrin Migraine OTC
First-line treatment choice for mild/moderate migraines or severe if worked in the past (has caffeine so watch for caffeine withdrawal headaches if taking daily0
NSAIDs
Migraines: prevents trigeminovascular inflammation
DOC for mild/moderate attacks or severe if worked before (use ASA, ibuprofen, or naproxen)
Use <15 days per month to prevent drug overdose headache
Watch for GI SEs
Ergotamine
Migraines, administer w/caffeine, lots of bad AEs, potent precipitator of med overuse headaches
CI in PVD, CAD, HTN
Pregnancy risk X, stimulates uterus
Do not use w/i 24hrs of a triptan (less effective than triptans)
Start early, pretreat w/anti-emetic for N/V, lots of AEs
Rectal better than oral
Dihydroergotamine
NOT ACCEPTABLE AS MONOTHERAPY
Nasal spray for migraines, but less effective than subQ sumatriptan (IM/subQ is similarly effective)
IV = TREATMENT OF STATUS MIGRAINOSUS (RASKIN PROTOCOL)
Less vasoconstriction & N/V than ergotamine, risk of ergotism, CI in CV conditions, potent precipitator of med overuse headache
Pregnancy risk X
List of Triptans
Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatriptan Zolmitriptan
1st line therapy for patients with MODERATE TO SEVERE MIGRAINES, and used for rescue therapy when nonspecific meds are ineffective
Triptans
AEs of Triptans
Chest symptoms, paresthesia, fatigue, dizziness, flushing, pain at injection site
Highest likelihood of consistent success was found w/ which 3 Triptans?
Rizatriptan, eletriptan, almotriptan
Most likely of one all triptans to produce short-term and sustained benefit
Eletriptan
Two triptans that are slower in onset and have lower efficacy?
Naratriptan and frovatriptan
2 Triptans with the most number of dosing formulations available?
Sumatriptan and zolmitriptan
How many days per month should triptan use be limited to?
Less than or equal to 9 days per month
CIs for use of triptans?
Patients w/ a history of IHD
Patients w/CAD need to have their first triptan dose where and how?
In the clinic w/vitals and maybe an ECG
Same in patients at high risk for it (i.e. HTN, hypercholesterolemia, obese, DM, smokers0
DIs include?
Don’t use w/i 24hrs of ergotamines
SEROTONIN SYNDROME (they notice b/c their hands start shaking)
What is the clinical triad of abnormalities experienced in serotonin syndrome?
Cognitive effects, neuromuscular dysfunction, autonomic dysfunction
This triptan contains a sulfa group…
Almotriptan
Antiemetic of choice in migraines?
Metoclopramide
What is the best way to prevent medication overuse headaches?
Acutely, discontinue the offending agent, but prevention is best - LIMIT USE OF MIGRAINE THERAPIES TO 2 DAYS/WEEK
Class of migraine meds absolutely contraindicated in pregnancy?
Ergots
What is the most common type of primary headache?
Tension headache
Pain thought to originate from myocardial factors and peripheral sensitization of nociceptors describes which type of HA?
Tension HA
Less than 10 HA episodes occurring on less than 1 day per month on average is?
Episodic tension-type HA
HA occurring greater than or equal to 15 days per month on average for greater than 3 months?
Chronic tension-type HA
What are the DOCs for tension HAs?
Analgesics (ASA/NSAIDs)
Limit use to no more than 9 days per month. Muscle relaxants can also be used
What is the DOC for prophylactic treatment of tension HAs?
Amitriptyline (TCA) - AEs = anticholinergic SEs, weight gain, oHTN, arrhythmia
In which type of HA are hypothalamic dysfunction and/or altered circadian rhythms suspected and/or genetic roles suspected?
Cluster HAs
The most severe of the primary HAs are?
Cluster HAs
HAs that tend to occur nightly, over a short period of time, followed by long periods of complete remission and occur predominantly in males in their 30s?
Cluster HAs
These HA attacks last 2 weeks to 3 months, often in spring and fall, occur suddenly with excruciating unilateral orbital/supraorbital/temporal pain where PT may sit and rock, or pace while clutching their head.
Cluster HAs
First line treatment of cluster HAs?
Oxygen, NRB, 7-10L/min
First line pharm treatment for acute cluster HA?
Sumatriptan is the best, but Zolmitriptan may be better tolerated in some PTs
What is the DOC in maintenance prophylaxis for cluster HAs?
Verapamil - reduce frequency and severity of cluster attacks
(2nd line is lithium)
Transitional prophylaxis meds of choice?
Prednisone
Dihydroergotamine has been used, but lacks evidence
