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Pharm > Headaches > Flashcards

Headaches Flashcards

1
Q

What % of office and ER visits involving headaches have serious pathology?

A

< 2%

< 4%

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2
Q

How do we classify headaches?

A

Primary (no other cause)

Secondary (some other cause)

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3
Q

What are some red flags of secondary headaches?

A

Change/progression in headache pattern
Abrupt onset
Neurological sx > 1 hour

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4
Q

How do you describe the pain of a tension headache?

A

Mild-moderate dull ache

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5
Q

What are tension headaches usually lacking?

A

Signs of serious underlying conditions
Visual disturbances
Generalized pain. fever, stiff neck, recent trauma
Bruxism

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6
Q

What are the OTC analgesics that pts often self treat tension headaches with?

A

Acetaminophen (56%)
Aspirin (15%)
Ibuprofen (12%)
Other agents (17%)

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7
Q

What NSAIDS and acetaminophen agents are more effective than placebos 2 hours after tx? What is their dosage?

A

Ibuprofen 400 mg po
Acetaminophen 1000 mg po
Ketoprofen 25 mg po

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8
Q

What should you limit analgesia intake per week to? Why?

A

2-3x/week

Prevent medication overuse headaches

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9
Q

What can you augment tension headache (TH) tx with? Give some examples.

A

Sedating antihistamines
Diphenhydramine
Promethazine

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10
Q

If augmented TH tx isnt working, what should you try?

A

Acetaminophen/ asprin w/ caffeine and butalbital

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11
Q

How often can you use the acetaminophen/caffeine/butalbital combination?

A

< 2xs weekly

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12
Q

What might the use of the combo TH therapy precipitate?

A

Chronic daily headahce

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13
Q

What are some things to worry about with the TH combo therapy? What do we do to deal with this?

A

Sedation

Limit alcohol

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14
Q

What are two drugs that are used as prophylaxis for TH?

A

Amitriptyline

SSRIs

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15
Q

How long might SSRIs take to be effective for TH?

A

1-2 months

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16
Q

What are some examples of SSRIs used for TH?

A

Paroxetine
Venlafaxine
Fluoxetine

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17
Q

What are the most painful of primary headaches?

A

Cluster headaches

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18
Q

What are some associated sx with cluster headaches (CH)?

A

Aura
Photophobia
Phonophobia
Osmophobia

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19
Q

What is a key feature of CHs?

A

Recurrent bouts of near daily attacks

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20
Q

How long may CHs last?

A

Weeks-months

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21
Q

When do CH attacks usually begin?

A

W/ REM phase sleep

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22
Q

What to pts susceptible to CHs fear?

A

Going to sleep

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23
Q

List some precipitants of a CH:

A

Hypoxia (sleep apnea)
Vasodilators
Alcohol
CO2

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24
Q

How are CHs dx?

A

Hx

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25
Q

Is CH pain UL or BL?

A

Unilateral

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26
Q

Where is the CH pain usually localized?

A

Orbital
Supraorbital
Temporal

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27
Q

CH pain is accompanied by >1 of:

A

Ipsilateral conjunctival injection or lacrimation
Ipsilateral nasal congestion or rhinorrhea
Ipsilateral eyelid edema, forehead & facial sweating
Ipsilateral miosis or ptosis, or
A sense of restlesness or agitation

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28
Q

What is the dual strategy for CH?

A

Acute attacks must be aborted or subdued

Prophylaxis used to suppress remaining CH

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29
Q

What is the tx of choice for CH? What is the dosage?

A

O2

7 L/min x 15 min

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30
Q

What is the medication commonly given for CH? What is the dose?

A

Sumatriptan
6 mg SQ
20 mg NS

31
Q

What is an under prescribed combo therapy for CH?

A

O2 and sumatriptan

32
Q

Give some other examples of CH tx:

A

Dihydroergotamine
Lidocaine
Capsaicin

33
Q

What is a tx for CH that is not effetive for CH prophylaxis?

A

Sumatriptan

34
Q

List the prophylactic drugs for CH:

A 
Verapamil
Prednisone
Valproic acid
Topiramate
Ergotamine
35
Q

How do we classify migraines?

A

By their clinical features

36
Q

What is one major feature of migraines?

A

Aura

37
Q

What can aura present with? How is that classified?

A

Visual distortions
Positive (scintillations, photopsia)
Negative (visual field defects)

38
Q

Describe migraine pain:

A

Unilateral
Throbbing
Temporal
Incapacitating

39
Q

How do you minimize migraine pain?

A

Dark, quiet location

40
Q

What are other sx that accompany migraines called?

A

Prodromal sx

41
Q

What are some common triggers for migraines? Give some examples.

A

Food (alcohol, caffeine, chocolate, MSG, tyramine, nitrate)
Behavioral/physiologic (changes in sleep, skipped meals)
Environmental (flickering lights)

42
Q

How quickly do we need to treat migraines?

A

Rapidly

43
Q

What are the goals of migraine tx?

A

Reduce frequency/severity of attacks

Avoid escalation of medications

44
Q

What should mild-moderate or unresponsive severe migraine attacks use for tx?

A

Oral NSAIDS
Combination analgesics containing caffeine
Isometheptene combinations

45
Q

What should mod-severe or mild mod unresponsive to NSAIDs migraine attacks use?

A 
Migraine specific meds
Combo tx (APC = aspirin, APAP, caffeine)
46
Q

What two things are not part of migraine tx?

A

Sedatives

Acetaminophen monotherapy

47
Q

Which is the superior care approach for migraines?

A

Stratified care (based on severity of disability)

48
Q

What are two abortive txs for migraines?

A

Ergotamine

Dihydroergotamine

49
Q

What is ergotamine?

A

Nonselective 5-HT1 agonist

50
Q

What is an advantage of dihydroergotamine?

A

Less overuse headache (replace ergotamine)

51
Q

What are some drawbacks of the abortive meds?

A

Both are oxytocic
Contraindicated in pregnancy
Peripheral vasoconstriction (short term use)

52
Q

What are triptans?

A

Specific 5HT1 receptor agonists

53
Q

What are triptans usually reserved for?

A

Mod-severe migraines unresponsive to other meds

54
Q

When are triptans contraindicated?

A

Uncontrolled HTN
Ischemic vascular conditions
Vasospastic CAD

55
Q

How quickly does subQ sumatriptan peak?

A

15 minutes

56
Q

How quickly does oral rizatriptan peak?

A

60-90 minutes

57
Q

What triptan has the longest half life? What might happen with this?

A

Naratriptan

Decrease chance of recurrence HA

58
Q

What are the principles of triptan therapy?

A

Try for 2-3 headache episodes before changing
If one is ineffective try another
Match drug characteristics to patient’s needs

59
Q

When do you consider prophylaxis for migraines?

A

> 2 attacks/month w/ disability > 3 days/month
Contraindications to/failure of abortive therapy
Presence of uncommon migraine conditions (hemiplegic migraine, prolonged aura)

60
Q

What is an uncommon tx for migraines?

A

OnabotulinumtoxinA

61
Q

What is the MOA of botox?

A

Neuromuscular blocking agent

62
Q

How many different sites do you inject with botox?

A

31 total sites

63
Q

What are CGRP antagonists for migraines?

A

Potent vasodilators of cerebral vessels

64
Q

What two things do CGRP antagonists do?

A

Block CGRP receptors

Inhibit CGRP directly

65
Q

What is CGRP receptor antagonist?

A

Monoclonal antibody

66
Q

What is the MOA of CGRP receptor antagonist?

A

Bind CGRP receptor blocking activation

67
Q

How much do CGRP receptor antagonists reduce migraines?

A

To 1-2 episodes/month

68
Q

How do you administer CGRP receptor antagonists?

A

SC injection once monthly

69
Q

When are CGRP receptor antagonists indicated?

A

Pts who fail other drugs

Prophylaxis of migraine

70
Q

What is the MOA of CGRP antagonists?

A

Prevents receptor activation by binding directly to CGRP

71
Q

How much do CGRP antagonists reduce migraine frequency?

A

1-2 episodes per month

72
Q

How do you administer CGRP antagonists?

A

SubQ injection once monthly

73
Q

When are CGRP antagonists indicated?

A

Prophylaxis when other drugs fail

Pharm (32 decks)

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