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Headaches Flashcards

1
Q

Treatment of headaches should begin with?

A

Non-pharmacological methods

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2
Q

Migraine treatment is classified as?

A

Specific/Nonspecific acute/abortive/symptomatic & preventive/prophylactic

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3
Q

Analgesics for migraine treatment are…

A

Nonspecific, Acute

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4
Q

Analgesics used for migraines?

A

aspirin, acetaminophen, naproxen, indomethacin, piroxicam, diclofenac, ibuprofen

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5
Q

Analgesic combination useful for moderate migraine?

A

Acetaminophen, Aspirin, Caffeine (Excedrin)

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6
Q

Barbiturates for migraine treatment are…

A

Nonspecific, Acute

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7
Q

Have barbiturates been shown effective in RCTs?

A

No

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8
Q

Barbiturates frequent side effects?

A

Drowsiness, dizziness, risk of overuse & withdrawal

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9
Q

Opioids for migraine treatment are…

A

Nonspecific, Acute

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10
Q

Opioids used for migraines?

A

Codein, meperidine, oxycodone, hydromorphone, morphine, methadone, butorphanol

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11
Q

Risks of opioid use?

A

High risk of overuse and development of chronic daily headaches – Should not be used more than 2 days/week

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12
Q

When are opioids for migraines most useful?

A

In pregnant patients (many other meds will be contraindicated)

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13
Q

Steroids for migraine treatment are…

A

Nonspecific, Acute

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14
Q

Steroids are most useful for?

A

Prolonged headache state (“status migrainosus”)

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15
Q

Ergotamines for migraine treatment are…

A

Specific, Acute

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16
Q

Ergotamine mxn?

A

Alpha-adrenergic & Serotonergic agonist

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17
Q

Ergotamine in combo with? Given as?

A

Caffeine; Oral tablet or suppository

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18
Q

Dihydroergotamine mxn?

A

Weak vasoconstrictor, 5HT1BD agonist: acts to reduce cell activity in the trigeminovascular system

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19
Q

DHE given as?

A

Nasal spray, IM, IV

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20
Q

DHE IV for?

A

status migrainosus

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21
Q

Common side effects of ergotamine and DHE?

A

Nausea (ergotamines more so than DHE), vomiting, chest pain, abdominal pain, dizziness

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22
Q

Ergotamine and DHE contraindicated in?

A

Pregnant women, uncontrolled HTN, sepsis, renal or hepatic failure, peripheral/coronary/cerebral vascular disease

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23
Q

Ergotamine and DHE use should not exceed…

A

2 dosage days/week

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24
Q

Premier migraine abortive meds?

A

Triptans

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25
Q

Triptans for migraine treatment are…

A

Speficic, acute

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26
Q

Name the seven available triptans.

A

Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan, Zolmitriptan

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27
Q

Most widely used triptan?

A

Sumatriptan

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28
Q

Sumatriptan is most effective given as?

A

SC (versus oral or nasal)

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29
Q

Triptan mxn?

A

5HT1BD agonists: Penetrate the CNS and cause vasocnstriction of extracerebral intracranial vessels and inactivation of the trigeminal system.

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30
Q

Is there evidence of use of triptans during the aura phase?

A

No, but shown to be effective in reducing associated symptoms.

31
Q

Triptan side effects?

A

Flushing, tingling, chest discomfort (noncardiac)

32
Q

Triptans contraindicated in?

A

Vascular disease, uncontrolled HTN, complicated migraine syndromes

33
Q

When is preventive therapy for migraine recommended?

A

More than 3 severe HAs/month, more than 2 mild-moderate HAs/week, inability to use effective symptomatic therapy, overuse of acute medications, patient preference and in special migraine syndromes

34
Q

Avoid preventive meds for migraine when?

35
Q

Major medication groups used for preventive therapy for migraines?

A

Antidepressants, antihypertensives, antiepileptics, vitamins, minerals, many “off label”

36
Q

Antidepressants for migraine treatment are…

A

Preventive

37
Q

First antidepressants used for migraine treatment? Then?

A

TCAs, SSRIs

38
Q

TCAs used for migraine treatment?

A

Amitryiptyline, nortriptyline, protriptyline

39
Q

Only TCA with consisten support for migraine prevention?

A

Amitryptyline

40
Q

SSRIs used for migraine treatment?

A

Fluoxetine, paroxetine, setraline (useful when coexistent depression)

41
Q

TCA side effects?

A

Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension

42
Q

SSRI side effects?

A

weight gain, sexual dysfunction

43
Q

Antihypertensives for migraine treatment are…

A

Preventive

44
Q

Commonly used antihypertensive classes for preventive migraine therapy?

A

Betablockers & Calcium channel blockers

45
Q

Beta-blockers used for preventive migraine tx? Which ones are FDA approved for this?

A

Timolol and propanolol (approved) + nadolol and atenolol (longer half life and tolerability, hence their use)

46
Q

Antihypertensives side effects?

A

drwosiness, depression, hypotension, decreased libido, memory disturbance

47
Q

Antihypertensives contraindicated in?

A

Asthma, diabetes, CHF, Raynaud’s

48
Q

Most commonly used calcium channel blocker for preventive migraine tx? When is this most useful?

A

Verapamil – Considered most useful in those with prolonged/disabling aura & for complicated migrain syndromes

49
Q

Side effects of verapamil?

A

Constipation, dizziness

50
Q

Antiepileptics as migraine treatment are…

A

Preventive

51
Q

What is divalproex sodium?

A

Extended release form of valproic acid formulation (AED)

52
Q

AED approved for migraine prevention?

A

Divalproex sodium

53
Q

Divalproex sodium side effects?

A

Sedation, hair loss, weight gain, tremor, changes in cognition, hepatotoxicity, blood dyscrasia, pancreatitis

54
Q

Most frequently used AED for migraine prevention?

A

Topiramate (approved)

55
Q

Topiramate side effects?

A

Changes in cognition, paresthesias, weight loss, kidney stones, acute angle-closure glaucoma, decreased sodium bicarbonate

56
Q

Botox for migraine treatment is…

A

Preventive for chronic migraines (>15 days/month for >3 months)

57
Q

Botox side effects?

A

injection site pain, HA post injection, neck weakness, ptosis

58
Q

Most common acute drug therapy for TTH?

A

Simple analgesics

59
Q

Analgesics in combo w/ what for acute TTH tx?

A

Caffeine, codeine, anxiolytics

60
Q

Most effective NSAIDs for acute TTH tx?

A

naproxen, ketorolac, indomethacin

61
Q

Will muscle relaxants help episodic TTH?

62
Q

When should preventiv drug tx be considered for TTH?

A

If frequence >2/week, if duration is >4/hour, and if severity may lead to significant disability or med overuse. This is the mainstay therapy for chronic TTH.

63
Q

Preferred preventive therapy for chronic TTH?

A

Antidepressants (TCAs, then SSRIs)

64
Q

Which TCA is most effective in preventive CTTH tx?

A

Amitriptyline

65
Q

Will muscle relaxants help prevent CTTH?

A

Yes. Example: Tizanidine

66
Q

Can Botox be used in preventive CTTH tx?

67
Q

Therapies for cluster headache acute treatment? Which is considered first line?

A

Triptans (first line), oxygen, DHE, anasthetics (lidocaine)

68
Q

Prophylactic therapy for cluster headaches can be?

A

Short-term, long-term

69
Q

Short-term prophylactic therapy for cluster headaches?

A

Oral corticosteroids, ergotamine

70
Q

Long-term prophylactic therapy for cluster headaches?

A

Verapamil, Topiramate, Divalproex, Sodium, Lithium

71
Q

Lithium side effects?

A

Weakness, nausea, thirst, tremor, lethargy, blurred vision, slurred speech, vomiting, anorexia, diarrhea, confusion, nystagums, EPS, seizures

72
Q

Avoid these with lithium? Why?

A

Indomethacin, Sodium-depleting diuretics – Increase lithium levels

73
Q

Most common cause of chronic daily headaches?

A

Med overuse

74
Q

Leading culprits of “rebound phenomenon”?

A

Caffeine & Barbiturates

Pharmacology (46 decks)

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