Headaches Flashcards
What are the preventative Medications for HA?
Beta blocker
Anticonvulsant
Antidepressant
Calcium channel blocker
Serotonin Antagonists
Analgesics:
-2 medications
NSAIDS
-2 medications
Combination Analgesics:
-3 medications
Analgesics:
Analgesics:
-Tylenol - 1st choice for PG and breastfeeding
-Aspirin - anti-inflamm and platelet aggregation
NSAIDS: BBW Cardiovascular events
- Ibuprofen (Motrin)
- Naproxen (Napersyn)
Combo Analgesics: Barbituates: -Fiorinal; butalbital/caffiene/ASA -Fioricet; butalbital/caffeine/Acetaminophen BBW: hepatotoxicity
*dont use this class more than 3x/mo, may be habit forming
Midrin: vasoconstriction, sedation, analgesic
Antiemetics
- drug names
- BBW
Promethazine (Phenegran) -PO, IM, IV, Rectal Prochlorperazine (Compazine) -PO, IM, IV, rectal Preg C
BBW: resp depression in less than 2yo and tissue necrosis (Phenergan), Dementia related psychosis (Compazine)
Reglan: BBW Tardive dyskinesia
Preg B
Triptans
- MOA
- CI
- SE
MOA: agonist effects on serotonin 5-HT1 receptors in cranial blood vessels and inhibition of proinflamm neuropeptide release
CI:
- CAD
- PVD
- Stroke
- Hemiplegic and basalar migraine
SE:
- nausea
- jaw, neck, or chest pressure or tightness
- fatigue
- burning sensation of the skin
Sumatriptan (Imitrex)
- routes of admin
- how often can it be repeated
- when do you take?
routes: PO, SubQ, Nasal
- can be repeated 2hrs after initial dose
- take at onset of HA, NOT during aura or predrome.
What are the other triptans?
- Naratriptan (Amerge)
- Rizatriptan (Maxalt) (disinegrating)
- Zolmitriptan (Zomig) (disinegrating)
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- half life = 26hrs, used for menstral migraines
Ergot Alkalods
- pregnancy
- BBW
- 2 medications & SE
Pregnancy X
BBW: life threatening peripheral ischemia, effects worse with pt on CYP3A4, protease inhibitors, and macrolide abxs.
Meds:
1.Ergostat; rebound HA and addictive
2.DHE 45 (Dihydroergotamie/Migranal) dry mouth, HA, N/V/D, muscle stiffness, cold clammy skin
What are the narcotic analgesics? WHen are these used?
- Demerol (meperidine)
- Morphine
- Oxymorphone
- hydromorphone (Dilaudid)
- Hydrocodone + acetaminophen (Norco)
- Oxycodone + acetaminophen (Percocet)
- Oxycodone
- Hydrocodone
- Fentanyl
-used as rescue medication for severe migraines in the ER when the patients rescue medication has failed them.
Combination Therapy for HA
Triptan + OTC Naprosyn with onset of HA
NSAID w/ antiemetic
Moderate narcotic w/ antiemetic
Preventative HA therapy
-medications
- Beta blockers (propranolol/inderal)
- anticonvulsants (Valproic acid/depakote) (topromax/topiramide)
- ANtidepressant (TCA, SSRI)
- Calcium channel blocker (Verapamil)
Beta Blockers
- meds
- SE
USED 1ST LINE PROPHYLACTIC THERAPY!!!
-Propranolol and Timolol
SE:
-fatigue, depression, impotence, hypotension
Calcium Channel Blockers
- meds
- SE
Meds: verapamil
*1st line cluster HA
SE:
-flushing, dizziness, constipation, peripheral edema
Anticonvulsants:
- meds
- SE
Valproic Acid (Depakote) SE: weight gain*, tremor, nausea, hair loss
need baseline LFT an CBC before starting
Topiramate(Topamax)
-SE: concentration/memory impairment, fatigue, weight loss*, nausea
Antidepressants :
- meds
- SE
Meds:
TCA: elavil (amitryptiline)
SNRI: effexor
SSRI: prozac, zoloft, paxil
SE:
-sedation, dry mouth, constipation, weight gain*
WHen do you initiate prophylactic migraine medication?
How long may it take to see effects of preventative therapies?
when they have less than 14HA, even if they just have 4 per mo that last longer than 12hrs
May take 2-6months
What are the types of HA? Describe age at onset, and common subtypes.
Primary: usually begin 20-40yo, MC are migraine and tension-type HA
Secondary: caused by underlying dz. ex: SAH
What are the 3 types of primary HA?
Types of secondary HA?
- migraine
- tension type HA
- cluster
- trauma (subdural, epidural)
- subarachoid
- meningitis
- brain tumor
- temporal arteritis
Migraine:
- MOA
- common in which gender, age?
- most common type
- exacerbating factors
Cause: dilation of blood vessels innervated by the trigeminal nerve
- women in 30-39yr
- without aura
Exacerbating Factors:
- emotional stress
- hormones in women
- not eating
- weather
- sleep disturbances
- odors
- alcohol
- smoke
Migraine
-what are 4 phases
- prodrome; sx 24-48hrs before, euphoria, depression, irritability
- aura: see bright lights, tinnitus, loss of vision, repetative jerking
- migraine HA: unilateral, throbbing pulsatile, N/V, photophobia, phonophobia
- migraine postdrome: feel drained or tired
Migraine Subtypes;
-migraine w/ brainstem aura: age at onset, aura consists of?
- hemiplegic migraine: manifestations
- retinal migraine: describe
- vestibular migraine: describe
- mesntrual migraine: describe
Brainstem: age 7-20yo, aura consists of:
- vertigo
- dysarthria
- tinnitus
- diplopia
- ataxia
- decreased LOC
Hemiplegic: unilateral motor weakness
- scintillating scotoma
- visual field defect
- fever
- numbness
- paresthesias
Retinal: repeated attack of monocular scotomata or blindness lasting less than one hour
Vestibular: episodic vertigo in patients with hx of migraines
Menstraul: occurs before and throughout mestruation
Migraine
-dx
Dx:
- no diagnostic test available, do neuroimaging only for
- -pts with unexplained abnormal finding on neuro exam
- -atypcial HA features or dont fit definition of migraine
- -red flag signs
Red flag Signs that could indicate something worse than migraine.
- “worst or first HA”
- significant changes in severity, frequency, or pattern
- new or unexplained neuro sx
- HA always on same side
- new onset HA after 50yo
- HA not responding to tx
- new onset in HIV or CA
- Stiff neck, fever, papilledema, cognitive impairment, personality change.
Dx Criteria for Migraine w/o aura
At least 5 attacks fulfulling the following:
- )HA last 4-72hrs
- )HA has at least 2 of the following
- unilateral location
- pulsating quality
- mod-severe pain intensity
- avoidance of routne physical activity - )During HA at least one of the following:
- n/v
- photophobia
- phonophobia
Migraine Tx
- first line = NSAIDS Aspirin
- second line = triptans
- third line = triptans + NSAIDS
- Opiods/barbituates MC used in ER.
