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Pharmacotherapeutics > Headaches > Flashcards

Headaches Flashcards

1
Q

What is the main difference between a migraine with aura and a migraine without aura?

A

In addition to typical migraine symptoms (such as headache, nausea, and sensitivity to light or sound), migraine with aura is characterized by the presence of neurological symptoms which can include visual disturbances (such as flashing lights or zigzag lines), sensory changes (such as tingling or numbness), or language difficulties.

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2
Q

What is the optimal treatment of migraine and how is it different from treatment of migraine with aura?

A

It focusses on symptomatic relief, hence involves the use of NSAIDs and/ or triptans.

Treatment for migraines with or without aura is the same.

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3
Q

What is the optimal treatment for cluster headaches and which drugs are avoided in it’s treatment?

A

Treatment: oxygen and/or subcutaneous triptans.

Avoid: NSAIDs, ergots, opioids, and oral triptans.

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4
Q

Give three examples of Triptans

A

Sumatriptan, Eletriptan, Zolmitriptan, Rizatriptan, Naratriptan and Nazatriptan.

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5
Q

Describe hemiplegic migraine

A

Affects one side of the body, occurs suddenly with severe headache, weakness in half of the body, with ataxia( problem with balance and coordination) and aphasia (language disorder)

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6
Q

State one side effect, one contraindication and one important interaction of Triptans

A

Side effect: Increases BP,
Contraindication : May cause coronary vasospasms, hence contraindicated in angina pectoris, coronary artery disease and myocardial infarction.
Interaction: May cause serotonin syndrome when given together with SSRIs

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7
Q

State one example of an ergot alkaloid

A

Ergotamine tartate

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8
Q

Why are ergots rarely used today

A

-Many side effects: Nausea, abdominal pain, vomiting, muscular cramps.

-Limited absorption

-Worsens cardiovascular and cerebrovascular conditions.

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9
Q

In simple terms, explain the MoA of ergotamine tartate

A

Causes vasoconstriction and hence reversing the vasodilatory effects which produces throbbing migraine.

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10
Q

What is the mechanism of action of Opioids?

A

They are agonists on the muscarinic receptors and also inhibit NA and 5HT reuptake in the CNS. These causes the drug’s analgesic effects.

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11
Q

Explain the prophylaxis of migraines

A

-Avoid triggers such as substance use, lack of sleep, irregular lifestyle, etc.
-Take drugs to prevent migraines such as anticonvulsants (valproate), antidepressants (SSRIs, TCAs, and MAOIs), and NSAIDS.

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12
Q

Which is the most common type of headache?

A

Tension type headaches

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13
Q

Which is the most common of all the headaches?

A

Tension headaches

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14
Q

Types of tension headaches

A

Infrequent episodic headaches
Frequent episodic headaches
Probable tension type headaches
Chronic daily headaches

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15
Q

Three clinical features of tension headaches

A

-Mostly bilateral (90%) of the time.
-Can be generalized or localized (back of head, neck)
-Nature of pain is mild, tightness, and moderate pressure. Pain not worsened by coughing, straining to stool or shaking the head.
-Duration: Hours, days, weeks or months.
-Associated features include: Anxiety, depression, insomnia, neck tightness/stiffness, migraine.
-More common in females

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16
Q

Which drugs are used to prevent migraines?

A

-Valproate (anti-seisure med) with quicker onset of action (few weeks) compared to others.
-Beta blockers

17
Q

List five potential causes of headaches

A

Skeletal muscle contraction
Refered pain (from eyes, neck, spine)
Meningeal inflammation
Dilation of intracranial blood vessels
Compression of cranial nerves

18
Q

What are the different classifications of migraines?

A

Migraine with aura
Migraine without aura
Probable migraine
Chronic migraine
Episodic syndromes
Complications of migraine

19
Q

Classifications of tension headaches

A

-Infrequent episodic tension-type headaches
-Frequent episodic tension-type
-Probable tension-type headache
-Chronic tension-type headaches

20
Q

List the classifications of secondary headaches

A

-Headache attributed to psychiatric disorders.
-Headache caused by refered pain from the eye, ear, neck, nose, sinuses, teeth and mouth.
-Headache attributed to non-vascular disorders like intracranial neoplasms and idiopathic intracranial hypertension.
-Headache attributed to cerebral/cranial vascular disorders like hemorrhage.
-Headache attributed to drug/substance use/substance withdrawal. E.g alcohol induced headaches, Triptans overuse headache.
-Headache attributed to homeostatic disorders
-Headache attributed to trauma of the head and neck
-Headache attributed to intracranial infections

-

21
Q

What is trigeminal autonomic cephalalgias

A

These are headaches and associated symptoms which seem to affect where the trigeminal nerve innervates. All types of TAC share common features and common pathophysiology.

Examples include:
-Cluster headaches
-Trigeminal autonomic reflex
-Paroxysmal hemicrania
-Hemicrania continua
-Probable TCA

22
Q

Explain the diagnosis of migraine with aura

A

Has criteria from A to D
A. At least two attacks which meet criteria B and C
B. Meets at least one of the following and fully reversible:
-Negative symptoms (vision loss) and/or positive symptoms (flickering lights, blind spots, stars falling or lines)
-Muscle weakness
-Sensory symptoms like numbness or tingling sensation.
-Dysphagia (difficulty with speech)
C. At least three of the following symptoms:
- At least one aura symptom spreads gradually over >=5 mins.
-At least one aura symptom is unilateral
-At least one aura symptom is positive
-Two or more aura symptoms occur in succession
-Each individual aura symptom lasts for 5-60mins
-The aura is accompanied or followed within 60mins of headache.
D. Not better accounted for by another ICHD-3 diagnosis.

23
Q

Explain diagnosis of migraine without aura

A

Has criteria from A to E
A. At least 5 attacks which meet criteria B-D
B. The headache should last 4-72hrs (untreated or unsuccessfully treated)
C. Meet at least two of the following:
-Unilateral location
-Pulsating quality
-Moderate or severe pain intensity
-Worsened with walking, or other physical activities.
D. Has at least one of the following:
-N/V
-Photophobia and phonophobia.
E. Not attributed to another disorder

24
Q

Explain diagnosis of Infrequent tension-type headache

A

Criteria from A-E
A: At least 10 episodes occuring 1day/month or 12days/yr and fulfilling criteria B-D
B: Lasting 30mins to 7days
C: Has at least two of the following
-Bilateral location
-Pressing or tightening
-Mild or moderate intensity
-Not worsened by physical activities like walking or climbing.
D: Has nor N/V, phonophobia or photophobia
E: Not better accounted for by another ICHD-3 diagnosis

25
Q

Explain diagnosis of frequent episodic tension-type headaches

A

Same as diagnosis for infrequent, except that the headache occurs on 1-14 day/month for at least 3months a year.

26
Q

Explain diagnosis of chronic Tension type headaches

A

Same as diagnosis of Infrequent episodic tension-type headaches, except for the fact that headache occur >=15 days/month for >3 months.

27
Q

Diagnosis of cluster headaches

A

Criteria runs from A to E
A: At least 5 attacks meeting criteria B-D
B: Severe and lasting 15-180 mins
C: Either or both of the following:
-Conjunctival injection and/or lacrimation, Nasal congestion/rhinorrhea, Eyelid oedema or Miosis and/or aptosis
-Restlessness or agitation
D: Occuring with a frequency between one every other day or 8 per day
E: Not accounted for by another ICHD-3 diagnosis.

28
Q

State and explain the five phases of migraine

A
  1. Prodrome: Food cravings, yawning, slurred speech, altered vision, thirst, fluid retention. Lasts 10-24hrs
  2. Aura: Positive and negative symptoms. Not always present and happen only for 10-20% of patients.
  3. Headache: Pulsating/throbbing, intense. Could be unilateral (60%) or bilateral (40%). Phonophobia, photophobia, N/V present, worsened with activities like hair combing, shaving, showering or wearing a ponytail.
  4. Resolution: comes after one sleeps in a dark room
  5. Recovery: Lasts about 30 hrs, patient feels drained/exhausted.
29
Q

List five migraine triggers

A

-Skipping meals
-Stress
-Lack of sleep or poor sleep quality
-Bright light/loud noise
-Menstruation
-Strenous activity

Pharmacotherapeutics (1 decks)

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