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Pharmacotherapy II > Migraine Kaakeh Exam 4 > Flashcards

Migraine Kaakeh Exam 4 Flashcards

1
Q

What headaches fall into the vascular headaches category?

A

Migraines, cluster, non-migraine vascular and vascular

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2
Q

What are some causes of secondary headache?

A

Trauma, aneurysm, neoplasm, systemic disorders, medication-induced

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3
Q

What type of headache can wake people up at night with intense pain?

A

Cluster HA

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4
Q

What type of headaches tend to be bilateral?

A

Tension headaches (can stem from chronic myositis and cervical osteoarthritis as well)

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5
Q

True or false: It is common for migraine headaches to be preceded by an aura.

A

False – only 15% migraines

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6
Q

What type of headache presents in a hangover?

A

Non-migraine vascular

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7
Q

Why should caffeine be used cautiously in treating a migraine?

A

Sleep is often required to terminate migraines.

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8
Q

What are the three theories of migraine pathophysiology?

A

Vasodilation, neurological (abnormal firing), and neurogenic dural inflammation theory (CGRF, substance P, NKA, NO)

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9
Q

What gender is at higher predisposition for migraines? Cluster headaches?

A

Migraine – women

Cluster – men

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10
Q

What are the five criteria for migraine with aura diagnosis? How many are needed for a diagnosis?

A 
Gradual onset, mild-severe intensity
Reversible, aura lasts 5-60 mins
HA follows aura within 60 mins
Normal neurologic exam
Nausea/vomiting, photophobia, phonophobia
Need 3 of 5 and minimum 2 attacks ever
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11
Q

What are the criteria for diagnosing migraine without aura? (minimum 5 attacks lasting 4-72 hours)

A 
2 of: 
Unilateral, pulsating, moderate-severe intensity, aggravated by routine physical activity
1 of:
Nausea and vomiting
Phototobia and phonophobia

Normal neurologic exam too.

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12
Q

What are prodrome migraine symptoms?

A

Fatigue and dizziness

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13
Q

What are the positive and negative visual aura symptoms?

A

Photopsias, teichopsia (positive) and scotomas, heimaopias (negative)

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14
Q

True or false: Sensory auras can be treated with OTC products.

A

False

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15
Q

If a patient experiences an aura, when should migraine treatment be started?

A

At first sign of aura symptoms

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16
Q

What are the two scoring systems for assessing migraine?

A

MIDAS (IV is high) and HIT-6

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17
Q

True or false: Stratified care, where treatment agents are considered based on severity, is preferred in migraines.

A

True

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18
Q

Acute migraine abortive therapy should be limited to ____ times per month.

A

2 times/month

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19
Q

How does metoclopramide help in migraine?

A

Stimulates gastric emptying which helps with nausea and improves absorption of antimigraine agents. Metoclopramide + aspirin may even be more effective than triptans in some patients.

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20
Q

How is metoclopramide dosed in migraine?

A

10mg PO at first sign of attack

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21
Q

How should aspirin be used for migraine?

A

One 325-1000mg PO dose at first sign of attack then a6h prn. Do not use enteric coated (liquid/effervescent better). MAX 4 grams daily. Not for PUD patients.

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22
Q

How is acetaminophen dosed in migraine?

A

1000mg PO at first sign of attack then 500mg PO q4-6 hours prn

23
Q

What is an IV NSAID used for migraine? Dosing?

A

Ketorolac 30-60mg IV/IM initially

24
Q

What is in excedrin migraine?

A

APAP 250mg, ASA 250mg, caffeine 65mg (max 4 tabs per day)

25
Q

Which combination product contains acetaminophen–fiorinal or fioricet?

A

Fioricet (aCETaminophen)

Fiorinal contains aspirin and is schedule III

26
Q

What opioid nasal spray can be used for migraine?

A

Butorphanol – 1 spray in 1 nostril. Limit 4/day

27
Q

What pregnancy category are triptans?

A

C – use only if potential benefits outweigh potential risk

28
Q

What triptan has the longest duration of action?

A

Frovatriptan (but slower onset)

29
Q

What triptan has especially good efficacy with low side effects?

A

Almotriptan

30
Q

Treximet is a combination product with sumatriptan and ______ synergistically.

A

Naproxen

31
Q

What conditions make triptans contraindicated?

A

CVD, CAD, PVD, uncontrolled HTN, hemiplegic/basilar migraines.

32
Q

What are the side effects for triptans?

A

Somnolence, nausea, dizziness, weakness, potential pain or pressure in chest, rare coronary artery vasospasm, angina, ventricular tachycardia or fibrillation, MI

33
Q

What major psychiatric drugs do triptans interact with?

A

MAOIs and SSRIs

In general, messing with 3A4.

34
Q

What triptan interacts strongly with propranolol?

A

Rizatriptan

35
Q

What are side effects of the ergotamines?

A

Cyanotic extremeties, ischemic bowel disease, renal dysfunction, N/V.
CI: same as triptans plus renal impairment, hepatic disease, glaucoma, pregnancy
Pregnancy X!

36
Q

What compound is added to every oral ergotamine product?

A

Caffeine

not in SL products

37
Q

How is dihydroergotamine dosed?

A

IV, IM, or SQ

1-2 mg initially, increase to max 2-3mg/day. Max 6mg/week.

38
Q

How are the ergotamine SL tablets dosed?

A

1 2mg tab SL at first sign then 2mg q30 min PRN, max 6mg/day and 10mg/week

39
Q

What acute migraine treatment can be used in pregnant and breast feeding women?

A

Isometheptene + APAP + dichloralphenazone (sedative) (Midrin)

40
Q

What is one an advantage of isometheptene?

A

Advantage – much safer than triptans and safe for pregnant women
May try Midrin after NSAID and before triptan.

41
Q

How long must a headache last to be considered status migrainosus?

A

Headache for >72 hours

42
Q

How do you treat status migrainosus?

A

Sumatriptan SQ, accompanied with anti-emetic and IVF

43
Q

What is second line for status migrainosus after triptan failure?

A

DHE 1mg SQ or ketorolac 30mg IV with or without corticosteroid
Haloperidol may be used. Avoid narcotics.

44
Q

When should migraine prophylaxis be considered?

A

If abortive therapies are used >2x/month or if vasoconstrictors contraindicated

45
Q

What are the four first line agents for migraine prophylaxis?

A

B-blockers, topiramate, tricyclic antidepressants, valproic acid

46
Q

What are first line agents for menstrual migraines?

A

Extended cycle oral contraceptive, intermitten estrogenn or NSAIDs

47
Q

What are the two beta blockers approved to reduce migraine severity?

A

Propraolol LA 80mg PO daily

Timolol 10mg PO BID

48
Q

How is topiramate dosed for migraine prevention?

A

25mg PO daily increased by 25mg every week to 100mg total. Risk of metabolic acidosis.

49
Q

What are the potential tricyclic antidepressants for migraine prevention?

A

Amitriptyline, doxepin, imipramine, nortriptyline, protriptyline, desipramine, trazodone
Normally a lower dose than used for depression.

50
Q

TCAs are the drug of choice for…

A

Mixed headache syndrome (chronic daily headache)

2-8 migraine attacks/month plus daily low grade tension headache

51
Q

What SSRIs prevent migraine?

A

Fluoxetine, sertraline, paroxetine

52
Q

What are characteristics of cluster headache?

A

Constant, unilateral pain in one eye orbit, nightly for weeks, same eye, extreme pain, autonomic symptoms (tearing, drooping, draining of nasal passage)

53
Q

What is the only approved treatment for cluster headaches?

A

Sumatriptan

Oxygen, meperidine, cocaine, DHE may be used

54
Q

What is another name for a medication-overuse headache?

A

Analgesic rebound headache.

Pharmacotherapy II (15 decks)

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