IC5 headache Flashcards
MOA for NSAIDs in tx of migraine
blocks COX enzymes, and subsequently inhibits prostaglandin synthesis
How many 5-HT1 receptor classes are there?
5 (A,B,D,E,F)
Typically, triptans achieve pain relief for migraine in ____
2h
CGRP is a peptide found throughout the body which acts as a ____
Vasodilator
CGRP levels increase/ decrease during a migraine attack?
Increase
Gepants act as ____
CGRP receptor antagonists; prevents signalling
S in SNNOOP10 stands for
Systemic symptoms including fever
What guide is used to identify red flags in secondary headache?
SNNOOP10
Primary Vs Secondary headache
Primary headache includes TTH, migraine, cluster headache
Secondary headache are headache caused by other sources e.g. infection, trauma, disorders (cranial, psychiatric, hormonal), facial structures
N in SNNOOP10 stands for
- Neoplasm in history
- Neurologic deficit or dysfunction
Features of TTH
- Bilateral
- Not aggravated by routine ADL
- Mild-moderate pain
- Tightening/ pressing pain
- Lasts around 30mins-7days
Is migraine always unilateral?
No, can be bilateral
Frequency of infrequent, episodic TTH per month
< 1 day/ month
Frequency of frequent, episodic TTH per month
1-14 days/ month
Frequency of chronic TTH per month
> /= 15 days/ month
Most common type of primary headache
TTH
O in SNNOOP10 guide stands for
- Onset of headache is sudden
- Older age > 50 y/o
Effective drugs for acute migraine treatment
- NSAIDs
- Triptans
- Ergotamine
- Ditans
- Gepants
Contraindication for triptans
- arterial hypertension, coronary heart disease, Hx of ischemic stroke
- pregnancy, lactation
- Raynaud’s disease
Ergot alkaloid vs Triptan: which is more efficacious?
Triptans; less side effects & faster pain relief at 2h mark
Effective drugs for preventative migraine treatment
- Antiepileptics
- BB
- Anti-CGRP antibodies
- Gepants
How is CGRP involved in migraine pathology
- CGRP released by trigeminal nerves can bind to CGRP receptors on 2nd order neuron -> pain transmission
- CGRP released by trigeminal nerves can bind to CGRP receptors on smooth muscle cells of meningeal blood vessel & mast cells -> neurogenic inflammation
Which beta blocker to consider for preventative migraine tx?
Propranolol, metoprolol
Contraindication for Ergotamine
cardio disease, coronary heart disease, cerebrovascular disease or uncontrolled HTN
