Hedaches Flashcards
For Mild to Moderate pain Migraine Headaches
NSAIDs and ASA
First line. For moderate to severe migraine headaches
Triptans. MOA- vasoconstriction- treats pain and nausea
Caffeine containing products used for migraines should not be used more than….
three days per month
Triptans are CI for….
Heart Disease Hx of stroke Angina Uncontrolled HTN Pregnancy with an SSRI ergots
Ergots for migraine
constrict intracranial blood vessels
inhibits neurogenic inflammation
activity at dopamenic receptors
Ergots CI:
Preg Cat X Not to be used within 24 hours of a triptan heart disease renal failure liver failure uncontrolled HTN
Cluster Headache treatment:
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
Prophylaxis for migraine
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
Define migraine HA
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.
Define Cluster HA
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.
Define tension HA
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.
Beta Blocker for Migraine prophylaxis
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
CCB for migraine prophylaxis
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
TCA for migraine prophylaxis
Can be used first line
amitriptyline nortriptyline imitripline
not to be used with a triptan- SS
Antiepileptics for migraine prophylaxis
Valproic Acid, topriamate
Preferred agent of BB is not tolerated
Just as beneficial as propranolol
Tension Headache prophylaxis
TCA
Cluster HA prophylaxis
CCB- verapamil
Tension Headache prophylaxis preferred treatment is
TCA first line
Effexor, Remeron second line
Cluster HA prophylaxis preferred treatment is
CCB- verapamil
lithium can be used for
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.
Migraines in pediatrics- pearls and treatment
more frequent in boys until puberty more frequent in girls post puberty Tylenol or Motrin, avoid ASA can give antiemetic- pref phenergan triptans >12yoa
HA in pregnancy- pearls and treatment
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
HA in pregnancy- CI
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.
primary HA
underlying attributable cause and include migraine, tension, and cluster.
Secondary HA
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.
Migraine HA triggers Behavioral
fatigue or sleep excess/deficit
female cycle- hormones
stress
excessive physical activity
Tension HA second line
NSAID- Motrin, aleve etc…
Diagnosis of Migraine with Aura
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
Diagnosis Frequent Tension Type
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 **
Diagnosis of Cluster HA
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
Migraine triggers - Food
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
Migraine triggers - Food
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
Migraine triggers - medication
estrogen/contraceptives indomethacin (NSAID used in gout, arthritis etc) cimetidine (antacid) nitrates nifedipine - CCB Reserpine Theophylline withdrawal of analgesic, decongestants, Benzos, ergots
Tension HA third line
Fioricet or Fiorinal - not to be used for more than 3 days - can causes MOH
CCB’s used
verapamil 120-320mg
amlodipine 2.5-10mg
Main AE- constipation
Define MOH and explain how it is treated
Overuse of OTC headache medications can cause rebound headaches. Cyclic.
Treating more than 2 HA or migraines can lead to MOH
BB’s used
timolol 20-30mg propranolol 80-240 atenolol 50-200mg metoprolol 50-200 nadolol 20-160
Anti epileptics used
Gaba 1200-2400mg Lamotrigine - 50-200mg Topiramate 50-200 Valproic Acid 500-1500 Depakote 500-1500
Dx of Migraine without aura
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
Tension HA Dx
frequent
When initiating drug therapy for Tension HA, ….
Hold OTC for 1-2wk
