Headache Treatments

Question 1

Ergots and triptans are what kind of headache treatment (acute or preventive, specificity)?

Answer 1

Acute, specific for migraines and cluster headaches

Question 2

Analgesics, anti-emetics, NSAIDs, corticosteroids, anxiolytics, and opioids are what kind of headache treatment (acute or preventive, specificity)?

Answer 2

Acute, nonspecific

Question 3

Botox is what kind of headache treatment (acute or preventive, specificity)?

Answer 3

Preventive, specific for migraines and chronic (not episodic) tension-type headaches

Question 4

Muscle relaxants like tizanidine are used in what kind of headache treatment (acute or preventive, specificity?)

Answer 4

Preventive, specific for chronic (not episodic) tension-type headaches

Question 5

Oxygen and anesthetics like lidocaine are used in what kind of headache treatment (acute or preventive, specificity)?

Answer 5

Acute, specific for cluster headaches

Question 6

Short-term preventive therapy for cluster headaches is used for less than a month, and involves administration of what two drugs?

Answer 6

Corticosteroids (short burst, oral) + ergots (daily)

Question 7

Anti-hypertensives like verapamil and anti-epileptics like topiramate and divalproex sodium are used in what kind of headache treatment (acute or preventive, specificity)?

Answer 7

Preventive, specific for migraines and cluster headaches

Question 8

A combination of what 3 drugs makes up the acute, moderate migraine treatment marketed as Excedrin?

Answer 8

Aspirin, acetaminophen, and caffeine

Question 9

What is the most common cause of chronic daily headaches?

Answer 9

Chronic use / overuse of medications

Question 10

What class of drugs is commonly prescribed as acute treatment for patients who wake up with a headache?

Answer 10

Opioids

Question 11

How do ergotamine and DHE treat headaches (what receptor, agonists or antagonists, what nerves)?

Answer 11

5HT agonists in the trigeminal pathway

Question 12

List 2 differences between ergotamine and DHE in treating headaches.

Answer 12

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)

Question 13

Ergots are used to treat what kinds of headaches, and are contraindicated in what kinds of patients?

Answer 13

Migraines (acute treatment) and cluster headaches (short-term prevention); contraindicated in pregnancy, hypertension, vascular disease, sepsis, hepatic or renal failure

Question 14

DHE is given intravenously for what severe headache state that lasts more than 72 hours?

Answer 14

Status migrainosus

Question 15

How do the triptans treat headaches (what receptor, agonists or antagonists, what nerves)?

Answer 15

5HT agonists in the trigeminal pathway

Question 16

How does the use of triptans compare to the use of ergots for headache treatment?

Answer 16

Triptans also treat migraines and cluster headaches, but can additionally treat accompanying nausea, vomiting, and photo/phonophobia

Question 17

Which triptan can be given as as a subcutaneous injection for immediate therapy? Which ones can be given as nasal sprays?

Answer 17

Sumatriptan; sumatriptan and zolmitriptan

Question 18

Which calcium channel blocker is most commonly used to treat headache? What kinds of headaches is it used for (acute or preventive; specificity)?

Answer 18

Verapamil; for prevention of migraines with prolonged or disabling auras, complicated migraines, and long-term cluster headaches

Question 19

Which anti-epileptic is most commonly used to treat headache? What kinds of headaches is it used for (acute or preventive; specificity)?

Answer 19

Topiramate; for prevention of migraines and long-term cluster headaches

Question 20

Divalproex sodium is the most common formulation of what chemical? What 4 problems is it used to treat?

Answer 20

Valproic acid; used for (1) all seizures including status epilepticus, (2) bipolar disorder, (3) migraine prevention, and (4) cluster headaches long-term prevention

Question 21

What are 4 unusual and important side effects to watch out for when using divalproex sodium?

Answer 21

Hepatotoxicity, pancreatitis, blood dyscrasias, and teratogenicity

Question 22

What are 5 unusual and important side effects to watch out for when using topiramate?

Answer 22

Metabolic acidosis, kidney stones, weight loss, word-finding/cognitive problems, and acute glaucoma (rare)

Question 23

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?

Answer 23

Indomethacin and Na-depleting diuretics, because they will cause an increase in [Li]

Question 24

Name the 2 β-blockers that are FDA approved for migraine prevention.

Answer 24

Propanolol and timolol

Question 25

Lithium is used for what kind of headache treatment (acute or preventive, specificity)?

Answer 25

Long term preventive for cluster headaches