IC5 Headaches and migraines

Question 1

Treatment of TTH

Answer 1

Paracetamol
Aspirin
NSAIDs

Question 2

Prophylaxis of TTH

Answer 2

Amitriptyline 10mg at bedtime
Venlafaxine
Mirtazapine

Question 3

ADR of triptans

Answer 3

Pressure on chest
Distal paraesthesia
Nausea
Fatigue

Question 4

Contraindications of triptans and ergotamines

Answer 4

Stroke/TIA
Uncontrolled hypertension
Coronary artery vasospasm
Ischaemic coronary artery disease
Peripheral vascular disease
Hx of basilar or hemiplegic migraine
GI ischaemia

Question 5

Triptans DDI contraindications

Answer 5

24h of ergot derivatives
2 weeks of MAO A inhibitors: selegiline, isocarboxazid, phenelzine, and tranylcypromine

Question 6

ADR of ergotamines

Answer 6

Nausea vomiting
Cramps
Transient lower limb muscle pain
Insomnia

Question 7

DDI of ergotamines contraindicated

Answer 7

24h of triptans
CYP3A4 inhibitors like macrolides, ritonavir

Question 8

Indication for gepants and ditans

Answer 8

Contraindicated or cannot tolerate triptans
inadequate response to 2 or more triptans trialed

Question 9

Medication overuse headache

Answer 9

Headache for at least 15 days/month for > 3 months

Triptans, ergot derivatives, opioids, combi of analgesics for at least 10 days/month

Simple analgesics, NSAIDs for at least 15 days/month

Any other combi of the above drugs for at least 10 days/month