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662 > Headaches > Flashcards

Headaches Flashcards

1
Q

Tension HA characteristics and?

A

Pressing/tightening (non-pulstatile), mild-mod intensity, bilateral, no aggravation by physical activity. Both: Nausea/Vomiting, +/- photophobia, phonophobia

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2
Q

Divalproex sodium contraindications

AEs, monitoring? What form is best

A
  • Severe hepatic insufficiency, preg, pancreatitis
  • GI upset, somnolence, weight gain, tremor, alopecia, hepatotoxic, thrombocytopenia, pancreatitis
  • CBT, LFTs
  • ER is better
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3
Q

Antiemetics are usually used as?

A

Adjunctive treatment with acute attacks

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4
Q

Rebound HAs Whats mess commonly cause?

A

Occur when analgesic medications are used excessively to treat HA - HAs increase in pain and intensity/ pain and occur daily - Discontinuation often leads to gradual reduction in frequency. - Analgesics, mixed analgesics containing but albeit also, caffeine, or isometheptene, erogotamine, opiates, triptans, Opiods and butalbital - Acute therapy no more than twice/week to protect against rebound

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5
Q

Other analgesics

A

Pts that are intolerant or contraindicated or for rescue therapy - Short acting barbiturates combined with ASA or APAP - Isometheptene compounds (Midrin) - Opiate analgesics (oral combos, parenteral, and butorphenol NS) - Tramadol - These commonly cause rebound headaches

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6
Q

Secondary Causes of infection

A

Infection, head injury, hemorrhage, Brain tumor, Drug induced (vasodilator, estrogen)

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7
Q

More common for women or men?

A

Women

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8
Q

What triptan should generally be avoided because of drug interactions?

A
  • Eletriptan
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9
Q

Summary of acute treatment guidelines

Nate SAID hid Pappy Trips ERlot when he takes Narcotics and Pukes

A

Typically you usually start with an NSAID, the APAP + ASA + Caffeine Then DHE nasal spray, Triptan Initial treatment with triptans in patient with mod-severe migraines

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10
Q

Preventative treatment

A

Titration, might need to try more than one.

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11
Q

What triptans should be used with N/V?

A
  • Sumatriptan
  • Zolmitriptan
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12
Q

Lower level evidence migraine prevention

A

SSRis, Gaba, Carb

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13
Q

Antiepileptics for migraine prevention?

A
  • Divalproex sodium
  • Topiramate
  • Gabapentin and Carbamazepine are less effective
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14
Q

Stratified and Step care approach

A

Strat: Rate HA prior to treatment - Use treatment based on severity, Better outcomes, Examples 1/5 main NSAID, 4/5 triptan Step care- always start with mild therapy and step up if HA persists Example: 1 use NSAID, 2nd analgesic combo, 3rd use triptan

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15
Q

What ergot alkaloid derivative is the only first line for treatment?

A

DHE NS after an NSAID is tried

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16
Q

Migraine prophylaxis

A
  • Beta blockers, antiepileptics, antidepressants, others
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17
Q

Acute Migraine Treatment DIs

Ergot and Derivatives?

A
  • Triptans within 24 hours
  • MAOIs (CI within 2 weeks)
  • Potent 3A4 inhibitor (CI)
  • SSRIs
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18
Q

Physicals and Labs for headache?

A

Physical exam, CT, MRI, LP, CBC, TSH

19
Q

POUND

A

Pulsating, One day, Uni, N/V, Disabling

20
Q

Antiemetics Commonly used agents

A
  • Combat N/V and vomiting that accompany the HA - IV metoclopramide has been known to treat pain - metoclopramide, prochlorperazine, promethazine - 15 minutes prior to oral acute treatment med - May be given parenterally or via suppository if needed - AEs CNS and EPS
21
Q

Ergot Alkaloid derivatives are generally?

A

Not recommended

22
Q

Acute treatment goals

A
  • Dont want recurrence, restore function
23
Q

Triptan DIS

A

MAOIs and ergot Dont use within 24 hours SSRIs and risk of serotonin syndrome -

24
Q

Non pharm treatment for HA

A
  • Relaxation training, Biofeedback, CBT, Avoid migraine triggers (bright lights, loud noise, allergens, weather changes, chocolate/cheese/ caffeine, Alcohol, MSG, Aspartame), Hormonal changes, sleep deprivation
25
Q

Types of Headaches 4

A

Migraine, Tension, Cluster, Rebound headache (medication overuse)

26
Q

Complementary/alternative products for migraine prevention?

A
  • Petasites (Butterbur extract)
  • Magnesium
  • Riboflavin
  • Feverfew
27
Q

Types of Migraines 4 types

A

Migraine with aura, migraine without, Menstrual migraine, Hemiplegic migraine

28
Q

History of Headaches

A
  • Age of onset, location, quality, severity, frequency, duration, triggers
29
Q

What triptans are a good choice for quick relief?

A
  • Almotriptan
  • Rizatriptan
  • Sumatriptan
30
Q

Beta blockers prophylactic?

What are the preferred ones?

Contraindications?

A

1st line prevention for migraines

  • Indicated for HTN, post MI, angina, HF, Anxiety,
  • Propranolol, Timolol, Metoprolol

Atenolol and Nadolol are also used but not as effective

  • Contraindication:
    • Bradycardia
    • 2nd/3rd degree heart block
    • Asthma/COPD
31
Q

Topiramate

Contraindications

AEs

Monitoring

A

No contra, no monitoring

AEs: Dizziness, somnolence, cognitive impairment, weight loss, nephrolithiasis, paresthesia

32
Q

Triptans and ____ interact with each other?

A

Triptans

33
Q

Beta blockers interact with?

A

RizaTriptan

34
Q

Migraine treatment Menstrual migraine

A

Prophylactic, NSAIDs, Triptans, Use OCs 2 days prior to menses then 3 days after onset of menses

35
Q

Level B

A

TCAs, SNRI, Beta-blocker (atenolol, Nadolol)

36
Q

Migraine for Acute

A
  • NSAIDs, APAP/ASA/Caffeine, triptans, Ergot alkaloids, Narcotic and other analgesics, antiemetics
37
Q

Triptans Drug interactions

A
  • Ergots
  • MAOIs
  • Potent 3A4 inhibitors
  • SSRIs
38
Q

Triptan AEs 1st line for?

A

For moderate-severe migraine - Somnolence, dizziness, paresthesias, warm sensation, flushing, chest symptoms (mimic angina)

39
Q

If there is patient tolerance what triptans should you use?

A
  • Almotriptan and Naratriptan
40
Q

Menstrual Migraine

A
  • only women no real difference in normal migraines
41
Q

Contraindication with Triptan

A

Cardiovascular disease, stroke, PVD, hemiplegic migraine, Multiple risk factors for coronary disease

42
Q

Level A migraine prevention

A
  • Divalproex/Sodium valproate - Topiramate - Beta-blocker (Meto, PRo, TImi)
43
Q

NSAIDs

A

1st line, Aspirin, Ibuprofen, Naproxen Excedrin - Dont recommend products with salicylates and caffeine such as (percogesic, BC, Goody’s Powder) - Monitor for rebound HAs - Caution with pts with renal disease, ulcer disease (GI bleed), or hypersensitivity to ASA - AEs: GI and CNS

44
Q

What tripans should be used in HA recurrence?

A
  • Frovatriptan
  • Naratriptan

662 (24 decks)

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