headaches and migraine Flashcards
serotonin receptors
5-HT 1-7; GPCR related except 5-HT3 > ligand gated ion channel
5-HT 1
in brain, GPCR, inhibit adenylyl cyclase
a. regulate mood and behavior
b-d against migraines, triptans
5-HT 2
in CNS and periphery
act through phospholipase C/IP3
excitatory
antagonist LSD in periphery
agonist LSD in CNS
5-HT 3
in periphery
cause excitation directly
antagonist; antiemetic (ondansetron)
5-HT 4
in CNS and periphery
excitatory via adenylyl cyclase
agonist; metoclopramide
antagonist; ondansetron
classification
primary;
migraine
tension headache
cluster headache
chronic daily headache
secondary;
head/neck trauma
cranial/cervical disorder
infection
substance abuse/withdrawal
headache place
migraine - unilateral
tension headache - bilateral, into forehead
cluster headache - unilateral, around the eye
sinus - associated with sinus
hormonal - low level of estrogen
migraine phases
premonitory (prodrome); fatigue
aura - visual; sensory; language
postdrome - headache hangover
pathophysiology
- vascular hypothesis > vasoconstriction (lifted by triptans)
- cortical spreading depression (potassium)
- inflammation of the trigeminal tract
treatment acute migrain
triptan - sumatriptan
ergotamines - dihydroergotamine
NSAIDs - ibuprofen
prophylactic treatment migraine
topiramate
valproate
divalproex
propanolol
migraine treatment pregnancy
sumatriptan
rizatriptan
NSAIDs > 2nd trimester only
propanolol?
paracetamol
migraine treatment children < 12
ibuprofen
topiramate
valproate
divalproex
propanolol
paracetamol
treatment cluster headache
high flow of oxygen
triptan
ergotamine
preventive; lithium, calcium channel blocker, verapramil, nifedipine, stop smoking
