Hedaches Flashcards

1
Q

For Mild to Moderate pain Migraine Headaches

A

NSAIDs and ASA

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2
Q

First line. For moderate to severe migraine headaches

A

Triptans. MOA- vasoconstriction- treats pain and nausea

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3
Q

Caffeine containing products used for migraines should not be used more than….

A

three days per month

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4
Q

Triptans are CI for….

A
Heart Disease 
Hx of stroke
Angina
Uncontrolled HTN
Pregnancy
with an SSRI
ergots
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5
Q

Ergots for migraine

A

constrict intracranial blood vessels
inhibits neurogenic inflammation
activity at dopamenic receptors

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6
Q

Ergots CI:

A
Preg Cat X
Not to be used within 24 hours of a triptan 
heart disease 
renal failure
liver failure
uncontrolled HTN
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7
Q

Cluster Headache treatment:

A

Can use the same as for migraines
if triptans or ergots can’t be used then sandastatin can be
100% O2 at 5-10L/min for 15 minutes

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8
Q

Prophylaxis for migraine

A
If pt has frequent HA, pain is severe, and medication is being used 2+ times per week, prophylaxis is indicated.
BB
TCA
NSAID
CCB
anticonvulsants
serotonin antagonist
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9
Q

Define migraine HA

A

common, recurrent, primary headaches of moderate to severe intensity that interfere with normal functioning and are associated with G.I., neurological, and autonomic symptoms.
They are more common in women than men.
Average age of onset is 15 to 35 years old with a peak between the ages of 35 to 45.
Family history is commonly seen.
They are unilateral in nature.
You will frequently see a premonitory symptoms or aura. Premonitory symptoms can include photophobia, hypersomnia, irritability, drowsiness, or appetite changes. These can occur hours to days before the onset of a migraine headache.


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10
Q

Define Cluster HA

A

Cluster headaches are less common than migraine and tension headaches.
They affect less than 1% of the population and are more common in males than females.
They result from a hypothalamus dysfunction causing disruption of circadian rhythms.
You usually see them at specific times during the sleep wake cycle at night.
The pain is very severe and centers around one eye.


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11
Q

Define tension HA

A

Tension headache is the most common type of primary headache.
Muscle contraction is the most significant factor that causes pain.
They are characterized by mild to moderate pain, non-pulsatile in nature, and bilateral.
The pain usually radiates from the forehead to the occiput. They are not associated with premonitory symptoms or auras.
They usually develop later in the day and are most commonly seen in adult females.


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12
Q

Beta Blocker for Migraine prophylaxis

A

propranolol and timolol
can’t use the triptan Riza with propranolol, must use other triptan
CI with pt who have airway disease and conduction issues

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13
Q

CCB for migraine prophylaxis

A

verapamil is most used. used for intolerance to BB, can take 6-8 weeks to see benefit, helps with pain and aura
2/3rd line

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14
Q

TCA for migraine prophylaxis

A

Can be used first line
amitriptyline nortriptyline imitripline
not to be used with a triptan- SS

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15
Q

Antiepileptics for migraine prophylaxis

A

Valproic Acid, topriamate
Preferred agent of BB is not tolerated
Just as beneficial as propranolol

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16
Q

Tension Headache prophylaxis

A

TCA

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17
Q

Cluster HA prophylaxis

A

CCB- verapamil

18
Q

Tension Headache prophylaxis preferred treatment is

A

TCA first line

Effexor, Remeron second line

19
Q

Cluster HA prophylaxis preferred treatment is

A

CCB- verapamil

20
Q

lithium can be used for

A

Cluster HA prophylaxis. Should be dosed at bedtime. The dose must be adjusted renally and monitored closely with serum levels. It is contraindicated in patients who are also on a thiazide diuretic, an ACEI, or an ARB.

21
Q

Migraines in pediatrics- pearls and treatment

A
more frequent in boys until puberty
more frequent in girls post puberty 
Tylenol or Motrin, avoid ASA
can give antiemetic- pref phenergan 
triptans >12yoa
22
Q

HA in pregnancy- pearls and treatment

A

Tension HA are seen more than migraine
HA due to estrogen flux
Tylenol is safest
Avoid NSAID in 3rd trimester, premature arteriole ductus closure
Opiods are second line, use sparingly
Prednisone, methylprednisone for iretractable HA preferred

23
Q

HA in pregnancy- CI

A

Triptans and ergots should be avoided
beta blockers and calcium channel blockers can lead to maternal hypotension.
Antiepileptic drugs have not been studied in this population.


24
Q

primary HA

A

underlying attributable cause and include migraine, tension, and cluster.

25
Q

Secondary HA

A

Secondary headaches can be attributed to a specific etiology and include headaches caused from trauma, infection, vascular or intracranial disorders, substance use, or medication overuse.


26
Q

Migraine HA triggers Behavioral

A

fatigue or sleep excess/deficit
female cycle- hormones
stress
excessive physical activity

27
Q

Tension HA second line

A

NSAID- Motrin, aleve etc…

28
Q

Diagnosis of Migraine with Aura

A

At least two of the attacks include:
Reversible Aura symptoms- visual, speech, motor, eye, brainstem

At least 2 of the 4:
1 aura for 5 min or two back to back
each aura last 5-60min
at least 1 aura is unilateral
aura is followed by a headache
29
Q

Diagnosis Frequent Tension Type

A

at least 10 episodes occurring 1-14d per month for > 3 most that:
last 30m-7d
No NV
Either photophobia or photophobia- not both
not attributed to another disease state
tightening in quality
bilateral
pain does not worsen with routine physical activity

**Infrequent THA are the same as above but occur less than one day a month on average **

30
Q

Diagnosis of Cluster HA

A

Severe pain, centers around one eye.
hypothalamic disruption that disrupts circadian rhythms
Occurs at specific times during the sleep wake cycle-
More common in men

31
Q

Migraine triggers - Food

A
ETOH
Caffeine intake/withdrawl
chocolate
citrus
bananas
figs/rasins
dair
fermented foods
monosodium glutamate
nitrites
saccharin/aspartame
sulfites- wine, shrimp etc
tyramine- cheese wine, beer, organ meats 
yeasts
32
Q

Migraine triggers - Food

A
ETOH
Caffeine intake/withdrawal
chocolate
citrus
bananas
figs/rasins
dair
fermented foods
monosodium glutamate
nitrites
saccharin/aspartame
sulfites- wine, shrimp etc
tyramine- cheese wine, beer, organ meats 
yeasts
33
Q

Migraine triggers - medication

A
estrogen/contraceptives
indomethacin (NSAID used in gout, arthritis etc)
cimetidine (antacid)
nitrates
nifedipine - CCB
Reserpine
Theophylline
withdrawal of analgesic, decongestants, Benzos, ergots
34
Q

Tension HA third line

A

Fioricet or Fiorinal - not to be used for more than 3 days - can causes MOH

35
Q

CCB’s used

A

verapamil 120-320mg
amlodipine 2.5-10mg
Main AE- constipation

36
Q

Define MOH and explain how it is treated

A

Overuse of OTC headache medications can cause rebound headaches. Cyclic.
Treating more than 2 HA or migraines can lead to MOH

37
Q

BB’s used

A
timolol 20-30mg
propranolol 80-240
atenolol 50-200mg
metoprolol 50-200
nadolol 20-160
38
Q

Anti epileptics used

A
Gaba 1200-2400mg
Lamotrigine - 50-200mg
Topiramate 50-200
Valproic Acid 500-1500
Depakote 500-1500
39
Q

Dx of Migraine without aura

A
At least 5 attacks that: last 4-72 hr
Has 2 of the 4:
unilateral
pulsating
moderate to severe pain
aggravated by routine physical activity, or avoidance of
40
Q

Tension HA Dx

A

frequent

41
Q

When initiating drug therapy for Tension HA, ….

A

Hold OTC for 1-2wk