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Unit 3: Pharm - Liza > Headaches > Flashcards

Headaches Flashcards

1
Q

What’s the difference between primary and secondary headaches?

A

Secondary headaches are attributed to other disorders (ie post-traumatic, vascular disorders, tumors etc); Primary headaches are when headache condition is a disorder unto itself

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2
Q

What is the distribution of migraine sufferers in male vs female?

A

women affected 3:1 in mid adulthood compared to males (22-55 yrs); prior and post, women and men more evenly affected

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3
Q

What are the four phases of migraine

A

prodrome, aura, headache, resolution

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4
Q

What happens in migraine prodrome?

A

(hrs/days before) change in mental status (drowsy, depressed, europhoric, hyperactive ,etc); phono/photophobia, yawning, difficulty concentrating, dysphasia, anorexia, food cravings, thirst, urination, fluid retention, stiff neck, etc

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5
Q

What is a migraine aura?

A

complex of focal neurologic symptoms (positive or negative) that follows/precedes/accompanies HA. lasts <60min, may occur w/out HA, visual aura most common; paresthesias 2nd most common

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6
Q

What happens during the headache phase of migraines?

A

unilateral, throbbing, aggravated by physical activity, relieved by rest; can become bilateral, last 4-72hrs, gradual onset/resolution, many assoc symptoms

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7
Q

What happens during the resolution phase of migraines?

A

headache wanes, person feels tired, washed out, irritable, impaired concentration, scalp tenderness, depression

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8
Q

What is the baseline pathophysiology for why migraines may occur?

A

1) genetic component (ex: familial hemiplegic migraine due to mutations on chromosome 19), plus twin studies etc
2) “sensitive brain” w/hyperexcitability and exaggerated responses

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9
Q

What is the pathophysiology of the aura phase?

A

associated w/reduction in cerebral blood flow (NOT a vascular phenomenon though); NOT due to vasoconstriction; more due to cortical spreading depression (neuronal dysfunction)

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10
Q

What is the pathophysiology of the headache phase?

A

involves activation of trigeminovascular system; where nerve fibers from V11 release vasodilating and permeability promoting peptides to cause sterile inflammation leading to increased sensitivity and pain

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11
Q

What are some behavioral treatments to prevent primary headaches from occurring?

A

healthy habits (sleep/diet/no smoking etc), stress management, biofeedback, trigger identification and avoidance

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12
Q

What are some examples of nonspecific medications used to treat migraines?

A

NSAIDs, COX2 inhibitors, combination analgesics, neuroleptics/antiemetics, corticosteroids, opiods

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13
Q

What are examples of specific medications used to treat migraines?

A

Ergotamines/DHE and Triptans

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14
Q

What are nonspecific medications useful in treating? Where to problems occur?

A

mild/moderate headaches, special populations (pregnancy, children, cardiovascular risks); caution to avoid overuse (especially with barbiturates)

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15
Q

What is the Rebound headache phenomenon?

A

symptomatic medications when taken daily can cause rebound phenomenon; medication overuse is MOST COMMON CAUSE OF CHRONIC DAILY HEADACHES (often from caffeine, barbiturates, and narcotics; but also from specific migraine meds)

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16
Q

How do Analgesics help with acute treatment of migraines?

A

COX-2 inhibitors usually preferred; Acetaminophen preferred in children due to danger of Reye’s; combo of acetaminophen/aspirin/caffeine (ie Excedrin) can be effective w/moderate migraines

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17
Q

When do Barbiturates help with acute treatment of migraines?

A

Used when more specific migraine meds aren’t available or are contraindicated; but risk of overuse/withdrawal, drowsiness and dizziness; thus limited to 2-3 times use/week

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18
Q

When do Opioids help with acute treatment of migraines?

A

Only for pts with infrequent headaches or for women that are pregnant (codeine or meperidine w/caution); only use 2 days/wk to avoid rebound

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19
Q

When do Corticosteroids help with acute treatment of migraines?

A

For pts with prolonged headache symptoms such as chronic daily headache

20
Q

What is the proposed MOA of Ergotamines and DHE (dihydroergotamine)?

A

possibly vasoconstriction and/or acting as a 5HT agonist in the trigeminovascular pathway (reducing cell activity)

21
Q

How is Ergotamine administered and how is DHE administered?

A

Ergotamine: suppository or tablet; DHE: IM, IV or nasal spray

22
Q

What are the common side effects with Ergotamines and DHE?

A

Nausea (*less w/DHE), dizziness, paresthesia, chest pain, abdominal cramps

23
Q

Who is contraindicated in taking Ergotamines and DHE?

A

women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease

24
Q

What are 3 advantages to DHE over Ergotamines?

A

less likely to cause rebound, have low HA recurrence rate, less likely to cause nausea

25
Q

What is the mechanism of action of the Triptans (ex:Sumatriptan)

A

Selective 5HT 1B-D agonists that penetrate the CNS to some extent, constricting extracerebral intracranial vessels and inhibiting the trigeminovascular system

26
Q

What are the Triptans effective in treating?

A

**premier migraine abortive drugs! plus effective for photo/phonophobia, N/V; pain relief for 80% taking subcutaneous doses and 60% other routes

27
Q

What do Triptans not treat?

A

aren’t helpful during the aura stage

28
Q

What are some contraindications and side effects in taking Triptans?

A

Contraindications = vascular disease (including Prinzmetal angina), uncontrolled HTN, complicated migraines

Side effects: flushing, tingling, dizziness, chest discomfort (non cardiac)

29
Q

What are some examples of adjunctive treatments used to tx acute migraines?

A

antiemetics and neuroleptics

30
Q

When would it be useful to use preventive treatment for migraines?

A

long-term use, preemptive, short term (menstruation), most used at low doses for chronic prevention when recurrent severe migraines >3/month, recurrent mild/moderate >2/wk, special migraine syndromes, etc

31
Q

What tricyclic antidepressants are used for preventive migraine treatment and what are the side effects?

A

amitriptyline, protriptyline, nortriptyline

side effects (rare): dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension

32
Q

What SSRIs are used for preventive migraine treatment and what are the side effects?

A

fluoxetine, paroxetine and sertraline

side effects: weight gain, sexual dysfunction

33
Q

What antihypertensives are used for preventive migraine treatment and what are the side effects?

A

**propanolol most used (FDA approved) and timolol (FDA approved); nadolol, atenolol

side effects: drowsiness, depression, decreased libido, HYPOTENSION; contraindicated w/asthma, diabetes, CHF and Raynaud’s

34
Q

What Calcium channel blockers are used for preventive migraine treatment and what are the side effects?

A

Verapamil – useful in patients with prolonged or disabling aura and for complicated migraine syndromes like hemiplegic migraine

side effects: constipation and dizziness

35
Q

What are some of the antiepileptic drugs used for preventive migraine treatment?

A

Valproic acid, topiramate (see Dr. Vertino flashcards for more info on these drugs)

36
Q

How does onobotulinumtoxin A (botox) used as preventive treatment and what are the side effects?

A

Unknown MOA (might decrease afferent stimulation of trigem, downregulating sensory and parasympathetic receptors, etc)

Side effects: injection site pain, headache, neck weakness, ptosis (distant toxin spread not expected)

37
Q

What are some characteristics of the tension type headache?

A

no prodrome or aura, mild to moderate in severity, pain is dull, achy, non-pulsatile, pressure-like; bilateral (band-like), neck or jaw discomfort, scalp tenderness, difficulty sleeping is trigger

38
Q

What are the IHS Criteria for Episodic tension type headaches?

A

headaches 30 min-7days w/some of the following: bilateral, no aggravation with physical activity, no nausea or vomiting, and only photophobia or phonophobia (1 or the other)

39
Q

What are the IHS Criteria for Chronic tension type headaches?

A

similar to episodic tension type headache but >15days/month for >6months and may be associated with disorders of pericardial muscles?

40
Q

What are the acute treatments for TTH?

A

analgesics (possibly in combo with opioids, barbs, caffeine)

41
Q

What are the preventive treatments for TTH?

A

TCA (Amitriptyline), SSRIs, muscle relaxants, botox

42
Q

What is the epidemiology of cluster headaches?

A

clockwork daily/annual rhythm; men affected 4:1, genetic component, pts w/heavy facial features (possibly due to smoking?)

43
Q

What is the IHS Criteria for Cluster Headaches?

A

severe unilateral orbital, supraorbital, temporal pain lasting 15 min-3hrs, associated w/lacrimation, nasal congestion, rhinorrhea, forehead/facial sweating, miosis, ptosis, eyelid edema, conjunctival injection, restlessness/agitation

44
Q

What is the pathophysiology of the cluster headache?

A

maybe due to dysfunction within hypothalamus interacting with trigeminovascular system

45
Q

What are the acute treatments for Cluster Headaches?

A

O2 via non-rebreathing masi, Sumatriptan, DHE (SC or intranasal), lidocaine nasal drops

46
Q

What are the short term preventive treatments for cluster headaches?

A

steroids (daily oral prednisone) or DHE daily oral

47
Q

What are the long term preventive treatments for cluster headaches?

A

verapamil, topiramate, valproic acid, lithium (which has many side effects and potential toxicity; avoid Na-depleting diuretics)

Unit 3: Pharm - Liza (14 decks)

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