Headache Treatments Flashcards
Ergots and triptans are what kind of headache treatment (acute or preventive, specificity)?
Acute, specific for migraines and cluster headaches
Analgesics, anti-emetics, NSAIDs, corticosteroids, anxiolytics, and opioids are what kind of headache treatment (acute or preventive, specificity)?
Acute, nonspecific
Botox is what kind of headache treatment (acute or preventive, specificity)?
Preventive, specific for migraines and chronic (not episodic) tension-type headaches
Muscle relaxants like tizanidine are used in what kind of headache treatment (acute or preventive, specificity?)
Preventive, specific for chronic (not episodic) tension-type headaches
Oxygen and anesthetics like lidocaine are used in what kind of headache treatment (acute or preventive, specificity)?
Acute, specific for cluster headaches
Short-term preventive therapy for cluster headaches is used for less than a month, and involves administration of what two drugs?
Corticosteroids (short burst, oral) + ergots (daily)
Anti-hypertensives like verapamil and anti-epileptics like topiramate and divalproex sodium are used in what kind of headache treatment (acute or preventive, specificity)?
Preventive, specific for migraines and cluster headaches
A combination of what 3 drugs makes up the acute, moderate migraine treatment marketed as Excedrin?
Aspirin, acetaminophen, and caffeine
What is the most common cause of chronic daily headaches?
Chronic use / overuse of medications
What class of drugs is commonly prescribed as acute treatment for patients who wake up with a headache?
Opioids
How do ergotamine and DHE treat headaches (what receptor, agonists or antagonists, what nerves)?
5HT agonists in the trigeminal pathway
List 2 differences between ergotamine and DHE in treating headaches.
DHE is given as a nasal spray, IM, or IV (while ergotamine is given orally), and causes less side effects (ex. nausea, rebound headache, uterine constriction, vasoconstriction)
Ergots are used to treat what kinds of headaches, and are contraindicated in what kinds of patients?
Migraines (acute treatment) and cluster headaches (short-term prevention); contraindicated in pregnancy, hypertension, vascular disease, sepsis, hepatic or renal failure
DHE is given intravenously for what severe headache state that lasts more than 72 hours?
Status migrainosus
How do the triptans treat headaches (what receptor, agonists or antagonists, what nerves)?
5HT agonists in the trigeminal pathway
How does the use of triptans compare to the use of ergots for headache treatment?
Triptans also treat migraines and cluster headaches, but can additionally treat accompanying nausea, vomiting, and photo/phonophobia
Which triptan can be given as as a subcutaneous injection for immediate therapy? Which ones can be given as nasal sprays?
Sumatriptan; sumatriptan and zolmitriptan
Which calcium channel blocker is most commonly used to treat headache? What kinds of headaches is it used for (acute or preventive; specificity)?
Verapamil; for prevention of migraines with prolonged or disabling auras, complicated migraines, and long-term cluster headaches
Which anti-epileptic is most commonly used to treat headache? What kinds of headaches is it used for (acute or preventive; specificity)?
Topiramate; for prevention of migraines and long-term cluster headaches
Divalproex sodium is the most common formulation of what chemical? What 4 problems is it used to treat?
Valproic acid; used for (1) all seizures including status epilepticus, (2) bipolar disorder, (3) migraine prevention, and (4) cluster headaches long-term prevention
What are 4 unusual and important side effects to watch out for when using divalproex sodium?
Hepatotoxicity, pancreatitis, blood dyscrasias, and teratogenicity
What are 5 unusual and important side effects to watch out for when using topiramate?
Metabolic acidosis, kidney stones, weight loss, word-finding/cognitive problems, and acute glaucoma (rare)
If a patient is being treated with lithium for long-term prevention of their cluster headaches, what 2 other medications should they take care to avoid, and why?
Indomethacin and Na-depleting diuretics, because they will cause an increase in [Li]
Name the 2 β-blockers that are FDA approved for migraine prevention.
Propanolol and timolol
Lithium is used for what kind of headache treatment (acute or preventive, specificity)?
Long term preventive for cluster headaches
