Headaches Flashcards
What are the 4 phases of a migraine headache?
1) prodrome (drowsy, irritable, photophobic)
2) aura (5-60 mins: focal neuro symptoms - visual or parasthesia)
3) headache (unilateral, throbbing, aggravated by physical activity)
4) resolution (hopefully)
Familial hemiplegic migraine is due to mutations of what and on which chromosome?
- chromosome 19, mutations of calcium channel
What kind of blood flow is happening during the aura and headache phases of migraines (usually)?
- aura: reduction of CBF, wave of depolarization
- headache: increase of CBF, activation of trigeminovascular system with release of vasodilatory and permeability promoting peptides
What are some nonpharmacologic ways to treat headaches?
- healthy habits (sleep, balanced meals, regular exercise, stop smoking)
- address psychological factors
- stress management, relaxation
- identify and avoid triggers
What are nonspecific meds to acutely treat migraines?
- NSAIDs
- COX-2 inhibitors
- neuroleptics/antiemetics
- corticosteroids
- opioids
A patient with a long history of migraines comes into your office sad and frustrated because he keeps having headaches. One of his previous doctors (because you would never make this mistake) gave him a barbituate for acute headache attacks. While taking a thorough history, you realize that he’s taking the barbs almost every day, and he’s drinking coffee like a mad man. What phenomenon is occuring?
- rebound headaches!
How do ergotamines work?
- act as a nonselective 5HT agonist in trigeminovascular pathway
- may also be a vasoconstrictor
What drug acts similarly to the ergotamines but has fewer side effects and can be used IV or for cluster headaches?
dihydroergotamine (DHE)
A patient comes to the ED in the thick of a severe migraine. What is the premier abortive treatment and how does it work? What conditions should you be sure they don’t have before you administer?
- triptans! (sumatriptan)
- works as a selective 5HT1b-d agonist
- Contraindicated in vascular disease, uncontrolled hypertension, and complicated migraines
What are indications that you should give a patient prophylactic migraine meds instead of acute abortive ones?
varies for each patient, but generally:
- greater than 3 severe migraines per month or greater than 2 moderate migraines per week
- inability to use effective symptomatic tx
Which tricyclic antidepressants are indicated for migraine and tension headache prevention and how does their prescription differ from their antidepressant action?
- amitriptyline, protriptyline, and nortriptyline
- given in very low doses
Which SSRIs are used to prevent migraine and tension headache and what are some side effects?
- fluoxetine, paroxetine, and sertraline
- SE: weight gain, sexual dysfunction
What antihypertensives can be used for prevention of migraine?
- beta blockers (propranolol, timolol, etc)
- calcium channel blockers (verapamil)
What AEDs can be used for prevention of migraine?
- valproic acid
- topiramate
You come to me complaining of frequent migraines. I tell you I want to inject something into 31 sites in your head and neck. What am I (probably) talking about?
- onabotulinum toxin
