Headaches Flashcards
1
Q
Pathophys of migraine
A
- activation of the trigeminovascular system
- vasodilating and permeability-promoting peptides released from pervascular nerve endings
- sterile inflammation and central pain processing
- mediated by presynaptic 5HT 1B-D receptors (inhibitory GPCRs)
2
Q
ergotamine
A
- 5HT 1B-D agonist
- migraine abortive tx and rescue tx for CH
- vasoconstriction and inactivation of trigem system
- SE: N+V, CP, abdominal pain, dizziness
- contraindications: preganancy, uncontrolled HTN, sepsis renal or hepatic failure, coronary, cerebral or peripheral vascular disease
- oral tablet or suppository form only
- **not really used because of the SE
3
Q
dihydroergotamine (DHE)
A
- 5HT 1B-D agonist
- vasoconstriction and inactivation of trigem system
- migraine abortive tx
- IM, IV or nasal spray
- IV mainly for status migrainosus
- weaker vasoconstriction, less emetic and less effect on uterus than ergotamine
- ** triptans > DHE > ergotamine
4
Q
triptans
A
- Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan, Zolmitriptan (mostly tablets, except sumatriptan which is IM too)
- 5HT 1B-D agonist; vasoconstriction and inactivation of trigem system
- premiere migraine abortive meds, CH
- also affective at reducing photo/phonophobia, N + V
- avoid use in PTs with vascular disease, uncontrolled HTN and complicated migraines (ie: hemiplegic migraines)
- well tolerated: SE = flushing, tingling, dizziness, chest discomfort
5
Q
Antidepressants
A
- TCAs: amitriptyline*, nortriptyline, protriptyline
- preventive/prophylactic tx of migraine and TTH
- avoid during pregnancy,
- SE: dry mouth, constipation, weight gain, cardiact toxicity and orthostatic hypotension
6
Q
Propanolol, Timolol
A
- Beta blockers used for prophylactic tx of migraines
- SE: drowsiness, depression, decreased libido, hypotension, memory disturbance
- contraindicated in PTs with asthma, diabetes, CHF, Raynaud’s
7
Q
Verapamil
A
- Calcium channel blocker (antihypertensive agent)
- prophylactic tx of migraines and CH, prolonged or disabling aura and for complicated migraine syndromes (hemiplegic migraine)
- SE: constipation and dizziness
- ** it is the weird drug that treats the weird HAs
8
Q
valproate
A
- AED
- prophlyactic tx of migraines and CH
- SE: sedation, hair loss, weight gain, tremor, changes in cognition, hepatoxicity, blood dyscrasias and pancreatitis (need to monitor CBC and LFTs)
9
Q
topiramate
A
- AED
- prophylactic tx of migraines and CH
- SE: cogntion, paresthesias, weight loss, kidney stones and acute angle-closure glaucoma, decreased serum bicarb
10
Q
Onabotulinumtoxin A (Botox)
A
- prophylactic tx of chronic migraine
- mech unknown
- SE: injection site pain, headache post injection, neck weakness and ptosis
11
Q
analgesics
A
- COX inhibitors
- acetominophen, aspirin, naproxen, indomethacin, indomethacin, piroxicam, ibuprofen
- acute tx of migraine and TTH
12
Q
barbs
A
- acute tx of migraine
- risk of OD, withdrawal and rebound HA
- use limited to 2-3 days/week
- SE: dizziness, drowsiness
13
Q
Opioids
A
- acute tx of migraines
- risk of overuse and rebound
- pregnant women may use codeine or meperidine with caution
14
Q
corticosteroids
A
- acute tx of migraines or prolonged HA syndromes (ie: chronic daily HAs), rescue tx of cluster HA
15
Q
cluster HA
A
- annual rhythm, occur at same time of day (usually after falling asleep)
- male > females
- leonine facies, smokers
- restlessness (unlike migraine), ipsilateral lacrimation, nasal congestion, rhinorrhea, facial sweating, miosis, ptosis, eyelid edema, conjunctival injection
- involvement of opthalmic division of trigem
- hypothalamic source?
