Headache meds. Flashcards
Severe headaches
¡ Migraine, cluster, and tension-type
¡ No identifiable cause
¡ Migraine ¡ Cluster
¡ Drugs used in two ways
o abort an ongoing attack
Aspirin-like drugs, opioid analgesics, and migraine-specific drugs
To prevent attacks from occurring
¡ Beta blockers, tricyclic antidepressants, and antiepileptic drugs
Characteristics-migraine
hrobbing head pain of moderate to severe intensity ¡ Nausea and vomiting
¡ Sensitivity to light and sound
¡ Highly debilitating
Characteristics ¡ Hormonal component ¡ Family history is typical ¡ Two primary forms ¡ Migraine with aura ¡ Preceded by visual symptoms ¡ Migraine without aura ¡ More common than with aura
Neurovascular disorder that involves the dilation and inflammation of intracranial
blood vessels
¡ Vasodilation leads to pain
¡ Neurons of the trigeminal vascular system
¡ Calcitonin gene–related peptide (CGRP)
¡ Serotonin (5-hydroxytryptamine [5-HT]) low
FACTORS THAT CAN
TRIGGER MIGRAINE HEADACHE
Food that contains the following:
¡ Tyramine (such as aged cheeses or Chianti wine)
¡ Nitrates (such as cured meat products)
¡ Phenylethylamine (such as chocolate)
¡ Monosodium glutamate (such as Chinese food or canned soups)
¡ Aspartame (such as diet sodas or artificial sweeteners)
¡ Yellow food coloring
Aborting an ongoing attack
Nonspecific analgesics
¡ Aspirin-like drugs and opioid analgesics
¡ Opioid analgesics (e.g., butorphanol, meperidine) ¡ Migraine-specific drugs
¡ Serotonin1B/1D receptor agonists ¡ Ergot alkaloids
¡ Preventing attacks from occurring
SEROTONIN 1B/1D RECEPTOR AGONISTS
Sumatriptan [Imitrex]
Mechanism of action
¡ Binds to receptors on intracranial blood vessels and causes vasoconstriction ¡ Diminishes perivascular inflammation
¡ Therapeutic use
¡ Aborting an ongoing migraine attack to relieve headache and associated symptoms
¡ Pharmacokinetics
¡ Oral or intranasal administration
Adverse effects ¡ Chest symptoms ¡ Transient “heavy arms” or “chest pressure” experienced by 50% of users ¡ Coronary vasospasm ¡ Rare angina as a result of vasospasm ¡ Teratogenesis ¡ Others ¡ Vertigo, malaise, fatigue, and tingling sensations ¡ Very bad taste when taken in intranasal form
¡ Drug interactions
¡ Ergot alkaloids, sumatriptan, and other triptans (all cause vasoconstriction)
¡ Preparations, dosage, and administration ¡ Oral
¡ Nasal spray
Ergot alkaloids: Ergotamine
Agonist activity at subtypes of serotonin receptors, specifically 5-HT1B and 5-HT1D
receptors
¡ Suppresses release of CGRP to block inflammation associated with the trigeminal vascular system
¡ Second-line drug for stopping an ongoing migraine attack in patients who have not responded to a triptan
¡ Risk for dependence
¡ Toxicity: Ergotism-vasoconstriction when extremities get cold and vasoconstrictor
¡ Drug interactions
¡ Physical dependence
¡ Contraindications
MIGRAINE HEADACHE
Preventive therapy
Beta blockers: Propranolol, timolol, atenolol, metoprolol, and nadolol
¡ Antiepileptic drugs: Divalproex [Depakote ER], topiramate [Topamax], gabapentin [Neurontin], and tiagabine [Gabitril]
¡ Tricyclic antidepressants: Amitriptyline [Elavil]
¡ Estrogens and triptans for menstrually associated migraine: Estrogen gel and patches
(e.g., Climara, Estraderm), frovatriptan, naratriptan, zolmitriptan, and naproxen sodium
Calcium channel blockers: Verapamil and nimodipine
¡ Botulinum toxin A
¡ Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers ¡ Supplements: Riboflavin (vitamin B2) and coenzyme Q-10
¡ Butterbur
CLUSTER HEADACHES
¡ Characteristics
¡ Occur in a series or “cluster” of attacks
¡ Each attack lasts 15 minutes to 2 hours
¡ Severe, throbbing, unilateral pain near the eye
¡ Lacrimation, conjunctival redness, nasal congestion, rhinorrhea, ptosis, and miosis on the same side of the headache
¡ One or two attacks every day for 2 to 3 months
¡ An attack-free interval of months to years separates clusters
¡ Treatment
¡ Primary therapy directed at prophylaxis
¡ Glucocorticoids (prednisone and dexamethasone) ¡ Verapamil
¡ Lithium
