headaches

Question 1

tension HA cause

Answer 1

maybe abnormal, heightened neuronal sensitivity

Question 2

tx of tension

Answer 2

ASA, tylenol, NSAID,

• can use ketorolac in severe HA
• local heat and muscle relaxants
• antidepressants +/- psychotherapy

Question 3

Migraine PP

Answer 3

intracranal vasospasm followed by extracranial vasodilation

maybe dysfxn of trigeminovasuclar systme–> pervascular release of substance P that leads to neurogenic inflammation

Question 4

what other dz can migraines be associated w?

Answer 4

sz disorders, essential tremor, tourette syndrome, depression, anxiety, sroke

Question 5

tx of migraines

Answer 5

abortive therapy: asa, acetominophen, NSAIDs, triptan, isometheptnee

ergotamines

Question 6

triptans MOA/ADR

Answer 6

sumatriptan, zolmitriptan, etc

selective serotonin agonist-produces vasoconstriction

dizziness, vertigo, flushing, chest tightness, sweating

serotonin syndrome

Question 7

ergotamine MOA

Answer 7

stimulates alpha adrenergic receptors–> producing peripheral vasoconstriction and decreased blood flow, also has serotonin antagonistic properties

Question 8

cafergot adr

Answer 8

N, V, intermittent claudication, photosensitivity

Question 9

migraine prophylaxis

Answer 9

BB (propanolol, metoprolol), tricyclic antidepressants, CCB, Valproic acid, topiramate

Question 10

CI to using triptans

Answer 10

basilar migraine (looks like a stroke)

-liver dz, uncontrolled HTN, hx of ischemic cardiac, cerebrovascular or peripheral vascular sndromes

Question 11

St. Anthony’s fire/ergotism

Answer 11

HA, V, D, gangrene

life threatening ischemia!!

Question 12

what meds do you need to watch when giving ergotamines?

Answer 12

mcrollides and protease inhibitors

Question 13

what can be used to tx a menstural migraine

Answer 13

frovatriptan