Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics 1 > Migraine > Flashcards

Migraine Flashcards

1
Q

What are the types of headaches?

A

tension (most common), cluster, migraine (recurrent, severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the cause of tension headaches?

A

muscle contraction and peripheral sensitization of nociceptors caused by a multitude of things, such as: stress, physical causes, dehydration, ect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the clinical presentation of tension headaches?

A

mild-moderate severity, non-pulsating, band-like pressure/tightness, bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 1st line acute treatment of tension headaches?

A

OTC acetaminophen or NSAIDs
note: no evidence for muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the 2nd line acute treatment of tension headaches?

A

if first line failed, prescription NSAIDs or combo products, such as: butalbital OR codeine + aspirin or acetaminophen
note: no evidence for muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the cause of cluster headaches?

A

decreased sympathetic and increased parasympathetic activity, vasoactive neuropeptide release and neurogenic inflammation, caused by heat, light, high altitude, cigarettes, alcohol, coffee, exercise, foods high in nitrites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the clinical presentation of cluster headaches?

A

-unilateral, severe, intermittent, sharp/stabbing
-parasympathetic symptoms= lacrimation (tearing), rhinorrhea (nasal discharge/mucus), sweating
-typically at night but may occur throughout day
-excited or restless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is 1st line acute treatment of cluster headaches?

A

100% oxygen mask

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is 2nd line acute treatment of cluster headaches?

A

if oxygen fails, -triptans or ergotamine derivative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What agents may be given to prevent cluster headaches?

A

-verapamil, lithium, corticosteroids, galcanezumab (Emgality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the dosing of galcanesumab (Emgality) for cluster headaches

A

300 mg subq at the onset of cluster period and then once monthly until end of cluster period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathophysiology of migraines?

A

serotonin (5-HT) is an important mediator of -> vascular vasodilation is a result of vasoactive neuropeptides (CGRP, neurokinin A, substance P) leading to inflammation and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the International Headache Society (IHS) diagnostic criteria for migraines?

A

-at least 5 attacks
-headaches last 4-72h
-must have 2 of the following characteristics: unilateral, pulsating, moderate-severe intensity, aggravation by or avoidance of routine physical activity
-during the headache, must have one of the following symptoms: nausea, vomiting, photophobia AND phonophobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does POUND stand for for migraine diagnosis?

A

-P: pulsating or throbbing pain
-O: one-day average duration
-U: unilateral location
-N: nausea or vomiting
-D: disabling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the goals of therapy for migraine treatment?

A

-reduce migraine frequency, severity, and disability
-improve quality of life
-minimize use of backup and rescue medications
-treat attacks rapidly and consistently
-optimize self-care, utilize cost effective treatments, and decrease emergency visits
-minimize adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the non-pharmacological treatment options for migraines?

A

-identify and avoid triggers
-lifestyle changes: regular sleep, exercise, limited caffeine, smoking cessation
-behavioral interventions: relaxation, cognitive behavioral therapy
-icepacks, rest in a dark area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are common triggers for migraines?

A

alcohol, caffeine, chocolate, fatty foods, loud noises, strong smells, smoke, flickering lights, menstraution

18
Q

When is migraine medication most effective?

A

when administered within 1 hour of symptom onset

19
Q

How many days a month is it recommended to take symptomatic medication?

A

< 10days

20
Q

What are the acute treatment options for migraines?

A

-analgesics
-serotonin agonists (triptans)
-lasmiditan
-ergotamine derivatives
-CGRP receptor antagonists (gepants)
-antiemetics
-opioids
-dexamethasone

21
Q

What is the 1st line treatment for mild-moderate pain associated with migraines?

A

analgesics

22
Q

What is the 1st line treatment for moderate-severe pain associated with migraines?

A

serotonin agonists (triptans)

23
Q

MOA: serotonin agonists (triptans)

A

increased vasoconstriction, inhibition of vasoactive peptide release, inhibition of transmission from trigeminovascular system

24
Q

Adverse Effects: serotonin agonists (triptans)

A

paresthesia, fatigue, dizziness, flushing, warm sensations, chest tightness, somnolence

25
Q

Contraindications: serotonin agonists (triptans)

A

ischemic heart disease, previous MI, hemiplegic/basilar migraine, uncontrolled HTN

26
Q

Precautions: serotonin agonists (triptans)

A

high risk for coronary heart disease (older men with risk factors and postmenopausal women) or SSRI use due to risk of serotonin syndrome

27
Q

Drug Interactions: serotonin agonists (triptans)

A

ergotamine derivatives, MAOIs

28
Q

MOA: Lasmiditan

A

serotonin (5HT1F) agonist, decreases trigeminal system without causing vasoconstriction

29
Q

Adverse Effects: Lasmiditan

A

dizziness (do not drive for 8h after taking medication)

30
Q

Indication: Ergotamine derivatives

A

moderate-severe migraine episodes, not generally first line due to tolerability

31
Q

MOA: Ergotamine derivatives

A

nonselective serotonin (5HT1) agonist, vasoconstriction of intracranial blood vessels and inhibition of neurogenic inflammation in the trigeminovascular system, caffeine enhances absorption and potentiates analgesia

32
Q

Adverse Effects: Ergotamine derivatives

A

nausea and vomiting, abdominal pain, weakness, fatigue, paresthesia, muscle pain, chest tightness, peripheral ischemia (rare)

33
Q

Contraindications: Ergotamine derivatives

A

pregnancy/breastfeeding, renal/hepatic failure, cardiac disease, uncontrolled HTN, strong CYP3A4 inhibitors

34
Q

Drug Interactions: Ergotamine derivatives

A

triptans, MAOIs

35
Q

What is the role of CGRP in migraines?

A

calcitonin gene-related peptide, a neuropeptide released from activated trigeminal sensory nerves, dilates intracranial and extracranial blood vessels and centrally modulates vascular nociception

36
Q

Indication: CGRP antagonists (gepants)

A

used for acute treatment or prevention of migraines

37
Q

Indication: antiemetics

A

treats N/V symptoms associated with migraines or used prior to giving medication during attack to improve absorption

38
Q

Indication: Opioids

A

last line for migraine treatment, inadequate evidence

39
Q

What are the indications to implement preventative therapy?

A

-recurrent migraines with significant disability despite acute therapy
- > 2 headaches/week
-issues with/failed acute therapy
-patient preference
-predictable patterns

40
Q

Indication: Anti-CGRP monoclonal antibodies

A

used for prevention (all except rimegepant which can be used for acute treatment), typically utilized when inadequate response or tolerance with at least 2 other agents

41
Q

Indication: OnabotulinumtoxinA

A

approved for the prevention of chronic migraines ( 15+ headaches/months lasting 4+ hours) in pt >18 yo

Therapeutics 1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions