Headache Therapy Flashcards
1
Q
describe a sinus HA
A
pain usually behind forehead and/or cheekbones
2
Q
describe a cluster HA
A
pain in and around one eye
3
Q
describe a tension HA
A
pain like a band squeezing the head
4
Q
describe a migraine HA
A
pain, nausea and visual changes
5
Q
what are classified as primary HAs?
A
tension-type, migraine, and cluster
6
Q
secondary HA disorders are defined as?
A
HAs which occur as a result of another health problem
7
Q
what is the most common primary HA type?
A
tension-type
8
Q
what is the other name for a tension-type HA?
A
ordinary or muscle-tension HA
9
Q
what are the triggers for tension-type HAs?
A
stress, anger, fatigue
10
Q
what type of HA describes mild-moderate, bilateral pain with a pressing/tightening feeling?
a. Cluster
b. Tension
c. Migraine
d. Sinus
A
b
11
Q
what are non-pharm treatments for tension HA?
A
palpation of pericranial nerves or cervical muscles
stress management
12
Q
how to treat tension HA if treatment failure with OTCs?
A
high dose NSAIDs
combo analgesics with butalbital or codeine
13
Q
Migraines are characterized by pain plus one or both of what 2 symptoms?
A
nausea/and or vomiting
photophobia and phonophobia (sensitivity to sound)
14
Q
women are more common to experience what type of HA? what hormone is a trigger?
A
migraines
estrogen
15
Q
which two types of HAs are considered vascular HAs?
A
migraine and cluster
16
Q
how are migraines characterized?
A
unilateral pain that’s pulsing, aggravated by physical stimul
17
Q
what are the two types of migraines?
A
common migraine (without aura) and classic migraine (with aura)
18
Q
what are visual symptoms of aura?
A
flickering, spots, vision loss, flashing lights
19
Q
what are sensory symptoms of aura?
A
numbness, tingling/pins and needles
20
Q
*auras can cause speech disturbances
A
.
21
Q
Imaging reveals aura is characterized by transient wave of activity in the ______ _____ followed by long-lasting ________
A
cerebral cortex, suppression
22
Q
cortical spreading of depression:
transient wave of ________ _______ activity in cerebral cortex followed by ________ and longer-lasting ________ in blood flow
A
depolarization excitation, repolarization, decrease
23
Q
*trigeminal neuron is activated by aura
A
.
24
Q
what are the four phases in order of time of occurrence of a migraine attack?
A
- prodrome premonitory
- Aura
- pain and associated symptoms
- postdrome
25
what is the job of the trigeminal nerve?
sends info about pain to brain stem
26
where in the brain is pain perceived?
thalamus and cerebral cortex
27
how do we treat trigeminal neuralgia?
with carbamazepine or oxcarbazepine
28
depolarization of trigeminal nerve causes release of CGRP which causes?
vasodilation
29
what are the 3 subunits of CGRP Rs?
calcitonin-like receptor
receptor activity-modifying protein
receptor component protein
30
tissue damage and the source of pain during a migraine is the ______ vasculature at the level of the _______
cerebral, meninges
31
what does vasodilation of blood vessels in brain do?
initiates a neurogenic inflammatory response
32
how do intracranial blood vessels utilize serotonin?
it is used to cause vasoconstriction
33
CGRP is co-expressed with which type of serotonin Rs?
5-HT1
34
the trigeminal nerve is an example of a ______________ nerve that expresses presynaptic serotonin Rs
non-serotonergic
35
what drug class is sumatriptan?
5-HT 1B/1D agonist
36
T/F sumatriptan can be used prophylactically for migraines
false
37
what is sumatriptans mechanism of action?
inhibits release of neuropeptides and causes vasoconstriction
38
serotonin's affinity for which 5-HT receptors increases the risk of side effects contraindicated in patients with ischemic heart disease?
5-HT 1B
39
second generation triptan drugs usually have ________ oral bioavailability and ________ half-life than sumatriptan
higher
longer
40
which triptan would be best if you are looking for one with a long half-life?
Frovatriptan
41
what is the name of the first CNS penetrating 5-HT 1F agonist?
lasmiditan
42
side effects from sumatriptan are most common via which route of administration?
subQ
43
what formulations is sumatriptan available as?
injection
nasal spray
oral
44
patients should not use triptans if they have what risk factors?
cardiovasc disease, risk of stroke, hypertension
45
are triptans safe in pregnancy?
inconclusive
46
triptans should not be co-administered with?
why?
another triptan
an ergot derivative
SSRIs, SNRIS, and MAO inhibitors
increased risk of serotonin syndrome
47
what drug class are Ubrogepant, Rigmegepant, Atogepant, and Zavegepant?
CGRP antagonist
48
T/F CGRP antagonists can be used prophylcatically
True
49
what does it mean to say Rigemegepant (Nurtec ODT) has duel efficacy?
its used as needed with onset of migraine and taken every other day to prevent migraines
50
Ergotamine and dihydroergotamine have affinity for _______ and _____ receptors, and their affinity for ______ receptors explains a direct ______ effect
dopamine, alpha, dopamine, emetic
51
why do ergot alkaloids have increased risk of drug-induced side effects?
they have low receptor selectivity
52
Ergot alkaloids, triptans, lasmiditan, and CGRP antagonists are effective for vascular HA and cluster HA, but not for what?
tension-type HA or facial pain
53
what is in fiorinal?
aspirin, butalbital and caffeine
54
what is in fiorinal with codeine?
aspirin, butalbital, caffeine and codeine
55
what is in fioricet?
acetaminophen, butalbital and caffeine
56
what is in fioricet with codeine?
acetaminophen, butalbital, caffeine and codeine
57
what is in midrin?
acetaminophen, isometheptene, and dichloralphenazine
58
what is in excedrin migraine?
acetaminophen, aspirin, and caffeine
59
what substance would exacerbate a rebound headache?
caffeine
60
what are the symptoms of a complex (atypical) migraine?
aphasia, slurred speech, limb weakness, touch sensations
61
what migraine medications should not be used to treat complex migraines? why?
triptans and ergot alkaloids
don't want vasoconstriction
62
what is a good treatment for complex migraines?
combo analgesics such as fioricet
63
what type of migraine is considered a channelopathy?
hemiplegic migraine
64
what are the symptoms of a hemiplegic migraine?
aura occurs as temporary unilateral weakness, usually before pain but can persist after
65
familial hemiplegic migraine sufferers have a mutation in the alpha subunit of the voltage-gated ________ calcium channel
P/Q-type
66
what migraine medications should not be used to treat hemiplegic migraines?
triptans and ergot alkaloids
67
what drugs can patients use to control nausea and vomiting caused by HAs?
metoclopramide
prochlorperazine
chlorpromazine
68
what is the common steroidal anti-inflamm drug used for migraines?
dexamethasone
69
beta blockers (metoprolol, propranolol...) are considered what type of migraine treatment?
prophylactic
70
antidepressants (SNRIs, amitriptyline) are considered what type of migraine treatment?
prophylactic
71
how do we determine if a pt is experiencing rebound HAs who have preexisting HA condition?
if they have a HA 15 or more days per month
72
when are rebound HAs the most painful?
in morning/upon waking
73
describe the process of how a migraine occurs
cortical spreading depression (aura): glutamate excitation in cerebral cortex followed by k+ repolarization and long-lasting decrease in blood flow
trigeminal nerve is activated to cause pain and nausea, photophobia, or phonophobia
TGN dumps vasoactive peptides like CGRP and causes vessel dilation
74
what is the relationship between triptans mechanism and the trigeminal nerve?
triptans target pre-synaptic serotonin receptors to modulate signals to the trigeminal nerve. the nerve is not directly affected by serotonin
75
T/F photophobia or phonophobia can occur, but not at the same time
true
76
how long can butalbital combos be used consecutively?
5 days
77
T/F tension type HAs are vascular
false
78
T/F cluster HAs are vascular
true
79
what is the main indicator of a cluster HA?
sudden stabbing of one eye
80
what are acute treatments of cluster HAs?
oxygen mask
triptans (non-oral)
intranasal lidocaine (if non-responsive to other treatments)
81
what drugs can be used to prevent cluster HAs?
verapamil
lithium
82
why do we not give triptans orally for cluster HAs or pts feeling nausea from HA?
they will vomit the drug up
83
where does pain and inflammation from a migraine occur specifically in the brain?
in the meninges (not the brain itself)
84
T/F migraines are vascular
true
85
what are the signs/symptoms of the prodrome premonitory phase of a migraine?
fatigue, irritability, cravings, mood changes, muscle tension
86
when should a patient use preventative therapy for their migraine?
right before they know the aura is coming
87
how long does the aura last before the pain starts with a migraine?
about 60 minutes
88
when should abortive therapy for migraine be used?
after patient begins to experience aura symptoms
89
what is the mechanism of NSAIDs?
they decrease prostaglandin inflammation
90
what drug class is lasmiditan?
selective 5-HT1F agonist
91
how do preventative treatments help with migraines?
they reduce severity and frequency of migraines, but do not prevent them
92
when should preventative treatments be prescribed on top of abortive treatments?
for pts having more than 15 migraines per month
93
Ergot drugs should not be administered _______, should not be mixed with _______ and should always be combined with _______ due to nausea
orally
MAOIs
antiemetics
94
T/F triptans all have equal efficacy
true
95
Gepants do/do not have renal dose adjustment, do/do not have repeat dosing, and are considered ______ line
do have renal dose adjustment. do not repeat dose. third line
96
Do gepants cause vasoconstriction?
no
97
do triptans cause vasoconstriction?
yes
98
do ditans cause vasoconstriction?
no
99
which triptans have more routes of administration than just oral?
sumatriptan, zolmitriptan, and rizatriptan
100
name the antiemetic drugs
metoclopramide
chlorpromazine
prochlorpromazine
101
why should metoclopramide be given with diphenhydramine?
it is a dopamine antagonist which increases risks of EPS
102
what drug is given IV to reduce brain swelling in severe attacks?
dexamethasone
103
what drug classes are used for preventative therapy?
beta blockers
antidepressants
anticonvulsants
CGRP MAB
botox
104
what is the CGRP MAB drug name we use for preventative therapy and what differentiates it from other preventative drugs?
remegepant, it also can be used as abortive therapy
105
which of the triptans are the only 2 with long duration? the other triptans have what length of duration?
naratriptan and frovatriptan
rest have short duration
106
which triptan has the longest half-life?
frovatriptan
107
which of the triptans have the shortest time for onset?
sumatriptan
eletriptan
zolmitriptan
rizatriptan
