Headache treatment

Question 1

Migraine characteristics

Answer 1

• Unilateral, gradual onset (4-72 hours), N/V, photophobia and phonophobia, Aura

Question 2

Tension headache characteristics

Answer 2

• Bilateral, pressure comes and goes

Question 3

Cluster headache

Answer 3

• Unilateral eye, quick onset, excruciating, lacrimation and rhinorrhea, sweating, horner’s syndrome,

Question 4

Mild HA and Menstrual HA usually treated with

Answer 4

NSAIDS

Question 5

Moderate to severe HA

Answer 5

give a short acting triptan (sumatriptan)

Question 6

Cluster HA

Answer 6

triptan or ergot

Or a “burst and taper” steroid like prednisone

Question 7

Analgesic overuse

Answer 7

too much migraine treatment, headaches get worse, start them on prophylactic treatment

Question 8

How do NSAIDs work

Answer 8

Inhibition of cyclooxygenase enzymes which decreases the synthesis of inflammatoyr mediators like prostaglandins

See sheet for NSAIDS most commonly used for migraine

Question 9

Triptan adverse effects

Answer 9

worst with SC SUmatriptan

• CNS effects- chest pain, coronary/peripheral vasospasm, contraindicated in heart disease, HTN, ischemic bowel dz.

Question 10

What drugs are contraindicated in use within 24 hours of triptan use

Answer 10

ergots, MAOI, propanolol, cyp3A4 drugs

Question 11

Treatment of headache in pregnancy is compicated. What are the big points

Answer 11

• NO ERGOTS EVER
• First trimester, your only option is acetaminophen
• Add opioids in later trimesters if you need to
• NO NSAIDS in the Third Trimester

Question 12

Oral contraceptives + smoking + migraines=

Answer 12

BIG RISK FOR STROKE

Remember that oral contraceptives are pro-clot

Question 13

What must you watch for with pts who take acetaminophen for headaches

Answer 13

G6PD deficiency

Question 14

How do triptans work

Answer 14

Selective for serotonin receptors B/D. They decrease the release of CGRP and substance P and thus lead to vasoconstriction

Question 15

Sumatriptan

Answer 15

This is the drug that can be given in a subcu injection for cluster headaches (10 min onset), also has an oral form (30 min) and a nasal spray (15min)

Question 16

Sumatriptan AEs….really just AEs for the triptans but they are worse for sumatriptan

Answer 16

CNS effects,
CHEST PAIN, CORONARY/PERIPHERY VASOSPASM
contraindicated in heart dz, HTN, ischemic bowel dz

Question 17

The two triptans we need to know

Answer 17

suma and ele

ELe has a 30 min onset and a longer half life (4.5hrs) than suma (2.5)

Question 18

In small doses, ergots cause what

Answer 18

vasoconstriction of small arteries

Question 19

In large doses ergots cause

Answer 19

paralyze the nerve endings of sympathetic fibers

Question 20

Adverse effects of ERGOTS

Answer 20

• NEVER use in pregnancy, cat x

Question 21

Metoclopramide

Answer 21

Central D2 blocker….remember it can be used pre-surgery to speed up the GI tract.

May give guys tits because of high prolactin

Question 22

Prochlorperazine

Answer 22

D2 blocker. Cholinergic and alpha adrenergic blocker. Causes the opposite of sludgebbb

Question 23

Chlorpromazine

Answer 23

D2 blocker. same as prochlorperazine

Question 24

Promethazine

Answer 24

cholinergic blockade

Anti-H1 and weak D2.

Question 25

ONLY APPROVED DRUG FOR PED MIGRAINE PROPHYLAXIN

Answer 25

Propanolol