Headaches

Question 1

Analgesics

Answer 1

C: –
M: Inhibition of COX (COX2 may be preferential)
T: Acute treatment of moderate migraine (combination of acetaminophen, aspirin, and caffeine); acute treatment of tension headaches
SE: –
MISC: –

Question 2

Barbiturates

Answer 2

C: --
M: --
T: Acute treatment of migraines; use when more traditional therapies unavailable or contraindicated
SE: Drowsiness, dizziness
MISC: Use limited to 2-3 times per week

Question 3

Opioids

Answer 3

C: –
M: –
T: Acute treatment of migraines; patients with infrequent headaches; generally, for patients who wake up with a headache
SE: –
MISC: Use less than 2 days per week; pregnant women may use codeine or meperidine with caution

Question 4

Corticosteroids

Answer 4

C: –
M: –
T: Acute treatment of migraines; migraine, prolonged headache syndromes (e.g., chronic daily headache); rescue treatment of cluster headache
SE: –
MISC: Chronic medicaton/overuse most common cause of chronic daily headaches

Question 5

Ergotamines

Answer 5

C: –
M: Vasoconstriction possibly; may also act as a 5HT agonist in trigeminovascular pathway
T: Acute treatment of migraines
SE: Nausea, dizziness, paresthesia, chest pain, abdominal cramps
MISC: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease

Question 6

DHE (Migranal)

Answer 6

C: –
M: Vasoconstriction possible; mainly act as a 5HT agonist in trigeminovascular pathway
T: Acute treatment of migraines; less likely to cause rebound headache than ergotamines; acute treatment of cluster headaches; short-term prevention of cluster headaches (along with steroids)
SE: Nausea (less likely than ergotamines), dizziness, paresthesia, chest pain, abdominal cramps
MISC: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; injectable

Question 7

Sumatriptan (Imitrex)

Answer 7

C: Triptans
M: Selective 5HT1b-d agonists; penetration of CNS, constriction of extracerebral intracranial vessels, inhibition of trigeminovascular system
T: Acute treatment of migraines (premier option); also effective for photo/phonophobia, nausea and vomiting; acute treatment of cluster headaches
SE: Flushing, tingling, dizziness, chest discomfort (noncardiac)
MISC: Contraindicated in vascular disease (including Prinzmetal), uncontrolled HTN, complicated migraine; injectable (suma)

Question 8

Onabotulinum toxin (Botox)

Answer 8

C: –
M: Unknown (possibly decreased afferent stimulation of trigeminovascular system, or downregulation of sensory and parasympathetic receptors)
T: Acute treatment of chronic migraine headaches
SE: Injection site pain, headache, neck weakness, ptosis
MISC: –

Question 9

TCA

Answer 9

C: –
M: –
T: Migraine prevention, tension headache prevention
SE: Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
MISC: Amitriptyline, protriptyline, nortriptyline

Question 10

SSRIs

Answer 10

C: –
M: –
T: Migraine prevention, tension headache prevention
SE: Weight gain, sexual dysfunction, headache
MISC: Fluoxetine, paroxetine, sertraline

Question 11

Beta-blockers

Answer 11

C: –
M: –
T: Migraine prevention (only propranolol and timolol FDA approved)
SE: Drowsiness, depression, decreased libido, hypotension, memory disturbance
MISC: Propranolol, timolol, nadolol, atenolol; contraindicated in asthma, diabetes, CHF, or Raynaud’s

Question 12

Calcium Channel Blockers

Answer 12

C: --
M: --
T: Migraine prevention; particularly useful in prolonged or disabling aura, or complicated migraine syndromes (e.g., hemiplegic migarine); long-term prevention of cluster headaches
SE: Constipation, dizziness
MISC: Verapamil most commonly used

Question 13

Oxygen

Answer 13

C: --
M: --
T: Acute treatment of cluster headaches
SE: --
MISC: Rebound can occur when oxygen stopped