Headache treatment Flashcards
Migraine characteristics
- Unilateral, gradual onset (4-72 hours), N/V, photophobia and phonophobia, Aura
Tension headache characteristics
- Bilateral, pressure comes and goes
Cluster headache
- Unilateral eye, quick onset, excruciating, lacrimation and rhinorrhea, sweating, horner’s syndrome,
Mild HA and Menstrual HA usually treated with
NSAIDS
Moderate to severe HA
give a short acting triptan (sumatriptan)
Cluster HA
triptan or ergot
Or a “burst and taper” steroid like prednisone
Analgesic overuse
too much migraine treatment, headaches get worse, start them on prophylactic treatment
How do NSAIDs work
Inhibition of cyclooxygenase enzymes which decreases the synthesis of inflammatoyr mediators like prostaglandins
See sheet for NSAIDS most commonly used for migraine
Triptan adverse effects
worst with SC SUmatriptan
- CNS effects- chest pain, coronary/peripheral vasospasm, contraindicated in heart disease, HTN, ischemic bowel dz.
What drugs are contraindicated in use within 24 hours of triptan use
ergots, MAOI, propanolol, cyp3A4 drugs
Treatment of headache in pregnancy is compicated. What are the big points
- 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
Oral contraceptives + smoking + migraines=
BIG RISK FOR STROKE
Remember that oral contraceptives are pro-clot
What must you watch for with pts who take acetaminophen for headaches
G6PD deficiency
How do triptans work
Selective for serotonin receptors B/D. They decrease the release of CGRP and substance P and thus lead to vasoconstriction
Sumatriptan
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)
