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555 > Migraine and Headache > Flashcards

Migraine and Headache Flashcards

1
Q

Prevalence of migraine

A

-higher in US than rest of world
-30% people experience Aura
-affects women more than men
-Peaks in ages 25-55
-40% of people benefit from treatment

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2
Q

Pathophysiology of migraine

A

-wide range of factors and mechanisms involved
-depends on genetics, anatomical, and environmental factors

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3
Q

Diagnosis of migraine

A

-ICHD-3 criteria
-at least 5 attack fulfilling the criteria

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4
Q

Cortical Spreading Depression (CSD)

A

responsible for aura and activation of trigeminovascular system

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5
Q

Dysmodulation

A

-theory that migraines w/o aura are associated with abnormal neuronal excitability and response to sensory stimuli

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6
Q

Describe process of CSD

A

-5HT and CGRP and other vasoactive neuropeptides released
-causes vasodilation, inflammation, and pain perception

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7
Q

Phases of a migraine attack

A

-predrome
-aura
-headache: mild, moderate, severe
-Postdrome

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8
Q

Criteria for Migraine without Aura

A

-4-72 hours
-pain (need 2 of 4): Intensity mod to severe, Unilateral, Pulsing/throbbing, aggravated with activity
-in addition to (1 of 2): N/V, Sensitivity to light/sound
-75% of people experiance neck pain

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9
Q

Tension type headache criteria

A

-30 mins to 7 days
-pain(2 of 4): Bilateral, pressing/tightening, mild to moderate, not aggravated by activity
-In addition to: no nausea, photo or phonophobia

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10
Q

Mnemonic for diagnosing Migraine Without Aura

A

-AUSTIN
-Activity aggravates
-Unilateral
-Sensitivity to light/sound
-Throbbing
-Intensity moderate to severe
-Nausea/vomiting

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11
Q

Episodic Migraine

A

< 15 HD/month

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12
Q

chronic migraine

A

> 15 HD/month

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13
Q

Headache History

A

-age of onset
-time from onset to peak intensity
-pain scale
-aggravating
-associated symptoms

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14
Q

Red flags for secondary headache

A

-Investigate SNOOP symptoms
-Systemic symptoms: fever, rash, stiffness
-Neurologic symptoms: confusion, weakness, vision changes
-onset: sudden, thunderclap
-Onset >40 years
-Pattern change: change in features

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15
Q

What is a migraine?

A

-loss of central inhibition and ability to accommodate various stressors

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16
Q

Migraine Triggers

A

-Fasting
-Medication
-Circadian Rhythms
-Environmental
-Hormones
-Stress

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17
Q

MIDAS

A

-Migraine Disability Assessment

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18
Q

Non-pharmacologic tratments

A

-biofeedback
-progressive relaxation
-cool compress
-rest in cool dark place
-hydration
-acupuncture/massage
-headache diary

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19
Q

Level A complementary treatments

A

-butterbur extract 75 mg BID

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20
Q

Level B complementary treatments

A

-feverfew
-Magnesium oxide (500mg/day)
-B2 (400mg/day)

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21
Q

Level C complementary treatments

A

-Coenzyme Q-10 300 mg/day

22
Q

Specific migraine medications

A

-for moderate to severe HA
-triptans
-ergotamine derivatives
-Gepants
-Lasmiditan

23
Q

Opiate medications for migraine

A

-Butorphanol
-tramadol
-Acetaminophen with (codeine/hydrocodone/tramadol)
-NO BUTALBITAL containing products

24
Q

Dihydroergotamine(DHE)

A

-high affinity for 5-HT1b/d
-interact with many others
-Many side effects: N/V, diarrhea, vasoconstriction
-Most effective at first sign of migraine
-risk of stroke and/or gangrene when taken with CYP3A4 inhibitors

25
Q

DHE dosage form

A

-nasal spray
-injection

26
Q

5-HT1 agonist

A

treatment of migraine

27
Q

5-HT2 antagonist

A

prevention

28
Q

5-HT3 antagonist

A

N/V

29
Q

What triptans can be repeated in 2 hours?

A

-Almotriptan
-Eletriptan
-Frovatriptan
-Rizatriptan
-Sumatriptan(PO, nasal spray, powder)
-Zolmitriptan(PO, Nasal spray)

30
Q

How often can you repeat a dose of Lasmidtan PO?

A

never, one dose in 24 hours
-don’t drive for 8 hours

30
Q

How often can you repeat a dose of Naratriptan?

A

-4 hours
-long half life

31
Q

Contraindications and precautions for triptans

A

-heart disease
-coronary vasospasm
-co concurrent us of ergot derivative
-pregnancy: minimize exposure
-MAOI
-SSRI

32
Q

triptan drug interactions

A

-MAOI: avoid within 2 weeks
-Ergots: avoid for 24 hours
-SSRIs and SNRIs: Serotonin syndrome
-oral contraceptive: increase triptan conc.

33
Q

Cimetodine/Zolmitriptan drug interaction

A

-use zolmitriptan 2.5 mg

34
Q

Propranalol and Rizatriptan

A

-increase triptan plasma conc by 70%

35
Q

Eletriptan drug interactions

A

-CYP3A4
-avoid nefazodone, clarithromycin
0azoles. grapefruit juice

36
Q

Common triptan side effects

A

-tingling
-warmth
-flushing
-chest and neck pressure
-dizziness
-somnolence
-abnormal taste with nasal formulations
-injection site burning at injection site
-REPORT CHEST PAIN

37
Q

Ubrogepant

A

-repeat in 2 hours
-nausea, somnolence, dry mouth

38
Q

Rimegepant

A

-orally disentegrating tab
-single dose

39
Q

Zavegepant

A

-nasal spray
-distorted tased, nausea, nasal discomfort

40
Q

Medication overuse headache

A

-more than 15 headaches/month for more than 3 months
-its important to ensure that patients do not over use their medications

41
Q

Who gets preventative migraine treatment?

A

-more than 4 migraines/month
-disruption in life
-a lot of pain

42
Q

Divalproex

A

-weight gain, hair loss, tremor, tetratogenicity
-migraine prevention

43
Q

Topiramate

A

-Migraine prevention
-weight loss, psycomotor slowing, difficulty concentrating
-teratogenicity

44
Q

Beta Blockers

A

-migraine prevention
-lowers BP and HR
-exercise intolerance
-depression
-contraindicated in asthma/COPD

45
Q

Tricyclic antidepressants

A

-migraine prevention
-sedation, weight gain, anticholinergic syndrome

46
Q

Botox

A

-chronic migraine headache
small doses in head and neck every 3 months
-sore neck, droopy eyelids
-effect noticed in a month

47
Q

CGRP antagonists

A

-migraine prevention
-reduce frequency of migraines by 50%
-constipation, site irritation
-EXPENSIVE
-can be combined with oral agents

48
Q

Rimegapant

A

-ODT 75 mg every other day
-migraine preventionA

49
Q

Atogepant

A

-migraine prevention and acute treatment
-10, 30, 60 mg daily

50
Q

Migraine with aura and birth control

A

-risk factor for ischemic stroke
-don’t use COC

51
Q

Menstrual migraine

A

-acute treatment: ergos or triptans
-phrophalactic treatment: NSAIDs(2 days before), Frovatriptan or naritriptan 6 days before
-COC extended dosing
-estradiol gel 6 days before and after
-magnesium day 15 to end of cycle

555 (12 decks)

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