Headaches Flashcards
Butalbital/acetylsalicylic acid and propoxyphene (APAP) (Fiorinal)
Mid-range analgesic/Combination analgesic
acetaminophen and propoxyphene (APAP) (Fioricet)
Mid-range analgesic/Combination analgesic
Isometheptene/acetaminophen/dichloralphenazone (Midrin)
Mid-range analgesic/Combination analgesic
Intranasal butorphanol
High-range/Narcotic analgesic
Limit to 2x/wk, addictive
Ergots
Treat migraines; (cerebral) vasoconstrictor
Pregnancy Cat X
Drug interactions: CYP3A4 inhibitors (including Macrolides); life threatening peripheral ischemia
ADRs: vasoconstrictor effects (blue fingers, paresthesias)
Cautions with PVD, CAD, HTN
Ergotamine (Ergostat, Ergomar)
Ergot for migraines
Dihydroergotamine (DHE)
Ergot for migraines
Safer than ergotamine- less peripheral vasoconstrictor effects
Triptans
Treat migraines
Serotonin receptor agonists; cause cerebral vasoconstriction
First line for moderate to severe migraines or for pts who don’t respond to NSAIDs
ADRs: dizziness, warm/hot sensation, coronary vasospasm (serious, not frequent), chest tightness, paresthesias
Contraindications: CAD, HTN
Coronary artery disease (coronary vasospasm) , uncontrolled hypertension (HTN)
Drug interactions:
Ergots, MAOIs, SSRIs
Sumatriptan (Imitrex)
Triptan
Migraine preventive therapy
Beta blockers (blocks beta receptors in vascular smooth muscle to prevent arterial dilation); CCB if don’t tolerate
Tricyclic antidepressants (acts on serotonin)
Antiepileptic drugs
Antiepileptic drugs for migraine prevention
Divalproex (Depakote)
Decreases the number and intensity of migraine
Baseline labs and close monitoring
Gabapentin (Neurontin)
Topiramate (Topamax)
Cluster HA Prophylaxis:
Glucocorticoids (including prednisone and dexamethasone) work rapidly but long-term ADRs)
Verapamil (1st line)
Lithium (2nd line)
Cluster HA Treatment
Sumatriptan
Sumatriptan
Cluster HA Treatment
Verapamil
First line prevention of cluster HA
