Headaches Flashcards by Stacey Hansen

3 types of primary headaches

Migraine, tension, cluster

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Type of primary headache that is located on one or both sides of the head, and migrates

Migraine

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Type of primary headache that is located on both sides of the head, with “hatband” presentation

Tension

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Type of primary headache that is located on one side of the head, often behind or near eye or temple

Cluster

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Type of primary headache that is more common in men

Cluster

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Type of primary headache that can last hours to days

Migraine

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Type of primary headache that can last for days

Tension

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Type of primary headache that lasts minutes to hours, but may repeat

Cluster

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Type of primary headache with mild to severe pain, gradual onset, with potential for throbbing pain sensation later

Migraine

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Type of primary headache with mild or moderate typically non-pulsating pain

Tension

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Type of primary headache with excruciating deep pain

Cluster

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Type of primary headache with accompanying motion, nausea, vomiting, sensitivity to light, sound or odors

Migraine

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Type of primary headache with accompanying redness or tearing of eyes, stuffy or runny nose

Cluster

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A wave of depolarization thought to activate trigeminal nerve afferents and cause release of vasoactive neural peptides and inflammatory mediators

Cortical spreading depression

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Cortical spreading depressing may manifest as aura in this type of primary headache

Migraine

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Migraine pathophysiology involves activity of this nerve

Trigeminal

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Type of primary headache involving trigeminal nerve activity and neuropeptide release

Migraine

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Vasoactive inhibitor peptide (VIP), Substance P (Sub P) and Calcitonin gene-related peptide (CGRP) are neuropeptides that may be released in this type of primary headache

Migraine

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In migraines, neuropeptide releases causes this effect on blood vessels

Vasodilation and plasma protein extravasation

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Neuropeptide release during migraines are negatively regulated by these receptors

5HT1Rs (serotonin receptors)

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5HT1Rs regulate this process that occurs during migraines

Neuropeptide release

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SNOOP is an acronym that indicates warning signs of this

Warning signs of secondary headache
S = systemic symptoms
N = neurological signs
O = onset
O = older age of onset
P = prior headache history

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Triptans, Lasmiditan, and Dihydroergotamines treat migraines through this mechanism

Prevent neuropeptide release
Are 5HT1 receptor agonists

Gepant drugs treat migraines through this mechanism

Block CGRPR activation (are competitive antagonists)

Drugs that are specific agonists of 5HT1B/D receptors

Triptans

Triptans are specific agonists of this

5HT1B/D receptors

Does triptan pre- or postsynaptic stimulation of 5HT1B/D receptors lead to inhibition of neuropeptide release?

Presynaptic

Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, or ergot use is contraindicated with use of this type of migraine drug

Triptans

Drug that is a specific agonists of 5HT1F receptors

Lasmiditan

Lasmiditan is a specific agonist of this

5HT1F receptors

Unlike triptans, this drug does NOT induce vasoconstriction, so it is not contraindicated in patients with cardiovascular conditions

Lasmiditan

Unlike this type of migraine drug, lasmiditan does NOT induce vasoconstriction, so it is not contraindicated in patients with cardiovascular conditions

Triptans

Unlike triptans, lasmiditan does NOT induce this, so it is not contraindicated in patients with cardiovascular conditions

Vasoconstriction

Second line treatment for migraines after triptans

Ergot alkaloid drugs

Type of migraine drugs that are nonspecific 5HT1 receptor agonists

Ergot alkaloid drugs

Ergot alkaloid drugs are nonspecific agonists of this

5HT1 receptor

Type of migraine drug with the following adverse effects: Nausea and vomiting (very common) Chest pain (angina) Tachycardia or bradycardia Vascular constriction and occlusion

Ergot alkaloid drugs

Type of migraine drug with the following contraindications: Peripheral vascular disease or coronary artery disease Hypertension Impaired liver function Pregnancy and breastfeeding Impaired renal function Should not be taken with vasoconstrictors

Ergot alkaloid drugs

Are triptans safe to use during pregnancy and breastfeeding?

Yes

Are ergot alkaloid drugs safe to use during pregnancy and breastfeeding?

Type of migraine drugs that are CGRP (calcitonin gene-related peptide) competitive receptor antagonists

Gepants

Gepants are competitive antagonists of this receptor

CGRP (calcitonin gene-related peptide) receptor

Type of drugs that are most commonly used for migraine prophylaxis MOA may be related to prevention of arterial dilation

Beta-adrenergic blockers

Type of drugs used for migraine prophylaxis with MOA of both enhancing GABA-mediated neuron inhibition and preventing vasodilation

Anticonvulsants (topiramate, divalproex)

Topiramate and Divalproex are this type of drug in migraine treatment

Anticonvulsants - used for prophylaxis

MOA of anticonvulsants (topiramate, divalproex) in prophylactic treatment of migraines

Enhancing GABA-mediated neuron inhibition Preventing vasodilation

Type of primary headache where pain originates from myofascial factors (referred pain) and peripheral nociception sensitization

Tension

First line treatment of tension headaches involves this

Simple analgesics and NSAIDS/acetaminophen Rx may be needed if simple analgesics and NSAIDS are inadequate

Type of primary headaches characterized by attacks of excruciating unilateral periorbital pain with ipsilateral cranial autonomic symptoms (tearing, rhinorrhea/congestion, edema, vision changes)

Cluster

Type of primary headache that occur in bouts or clusters lasting several weeks to months Bouts are separated by remission periods of 1 month or more

Cluster

Type of primary headache that is treated with abortive therapy (Oxygen (100%) delivered by nonrebreather facial mask, 7-10 liters/minutes for 15-30 minutes)

Cluster

What is the treatment for cluster headaches?

Abortive therapy - 100% oxygen delivered by facial mask (7-10 L/min for 15-30 min)

These 3 drugs are used as prophylaxis for cluster headaches

Calcium channel blockers (verapamil) Lithium (manic-depressive agent) Melatonin

Calcium channel blockers (verapamil), Lithium (manic-depressive agent) and Melatonin are used as prophylactic therapy for this type of primary headache

Cluster

This calcium channel blocker can be used in prophylactic therapy of cluster headaches

Verapamil

These different types of drugs can be used for migraine prophylaxis

Beta-adrenergic blockers Anticonvulsants Tricyclic antidepressants Serotonin-norepinephrine reuptake inhibitors Drugs targeting CGRPR (e.g. gepants)

Are gepant drugs used for migraine acute treatment or prophylaxis?

Both