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PR - CNS > MIGRAINES + HEADACHES > Flashcards

MIGRAINES + HEADACHES Flashcards

1
Q

Which drugs are used for headaches?

A
  1. Clonidine
  2. Verapamil
  3. Sumatriptan, Zolmitriptan
  4. Analgesics
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2
Q

Clonidine

A
  • A centrally acting antihypertensive
  • Used for the prevention of recurrent migraines and prevention of vascular headaches
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3
Q

Verapamil

A
  • Rate-limiting CCB
  • Prophylaxis of cluster
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4
Q

Sumartriptan, Zolmitriptan

A
  • Cluster headaches
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5
Q

Analgesics

A

e.g. Paracetamol, Ibuprofen

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6
Q

What are the symptoms of migraines?

A
  • Unilateral (affecting one side of the head)
  • Alterations in vision
  • Tingling/numbness on one side of the body lin lips, fingers, face, or hands) before an attack starts
  • N+V
  • Photophobia
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7
Q

In which gender are migraines more common?

A

Women

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8
Q

How long do Migraines last for?

A
  • Reccurent: 4-72 hours
  • Episodic: less than 15 days per month
  • Chronic: Headache for more than 15 days and migraine symptoms for at least 8 days a month for longer than 3 months
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9
Q

What are the two types of migraines?

A
  1. Migraine
  2. Migraine with aura
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10
Q

Migraine with aura

A
  • Typical unilateral headache
  • visual symptoms e.g. zigzag or flickering lights, spots, lines, or loss of vision
  • sensory symptoms e.g. pins and needles, or numbness
  • dysphasia
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11
Q

What are some trigger factors for migraine?

A
  • Stress
  • Relaxation after stress
  • Certain foods and drinks
  • Bright lights
  • Menstruation (due to a drop in oestrogen levels)
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12
Q

How do you treat a migraine?

A
  1. Simple analgesics
    - Aspirin, Paracetamol (preferable in soluble or dispersible form)
    - NSAID (Tolfenamic acid licensed specifically for migraines)
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13
Q

When should patients administer treatment for migraines?

A
  • Migraine onset ASAP
  • In migraine with aura, triptans should be taken in beginning of migraine e.g. headache, NOT when aura starts unless aura and headache happen at start together.
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14
Q

Why is dispersible/ solution preferred

A
  • Peritalsis is reduced in attacks of migraines
  • absorption is affected
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15
Q

Ergot Alkaloids and migraine

A

Ergotamine tartrate
- Its use is limited by
difficulties in absorption and by its side-effects.
- Treatment should not be repeated at intervals of less than 4 days
- Treatment should not be repeated more than TWICE a month
- Can be given for cluster headaches at a low dose for 1-2 weeks

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16
Q

Ergotamine tartrate - SE

A

N&V,
abdominal pain, and muscular cramps

17
Q

What is the risk of excessive use of acute treatments for migraines?

A

associated with medication-overuse headaches

18
Q

What can you give for
N&V associated with Migraines?

A

Antiemetics
- e.g. metoclopramide, domperidone, phenothiazine, and antihistamines
- Metoclopramide or domperidone may be better since they promote gastric emptying and normal peristalsis
- ONSET

19
Q

Oral contraceptives and migraine

A
  • COMBINED oral contraceptives can provoke migraine
20
Q

When would patients be indicated for prophylaxis of migraines?

A
  • Suffer at least 2 attacks a month
  • Suffer an increasing frequency of headaches
  • Suffer significant disability despite suitable treatment for migraine attacks
  • Cannot take suitable treatment for migraine attacks
21
Q

What treatments are used for migraine prophylaxis?

A
  1. Beta-Blockers
  2. TCAs
  3. Gabapentin
  4. Topiramate
  5. Sodium valproate and valproic acid
  6. Pizotifen
    - Limited use
    - Cause weight gain as side-effect
22
Q

Beta-Blockers

A
  • Propranolol (MOST COMMON)
  • Atenolol (unlicensed)
  • Metoprolol
  • Nadalol
  • Timolol
  • Bisoprolol (ulicensed - but useful if patient already taking for an existing cardiac disorder)
23
Q

Pizotifen

A
  • Limited use
  • Cause weight gain as side-effect
24
Q

When would you give botulinum toxin A in migraines?

A
  • Only initiated by specialists
  • When 3 or more
    prophylactics treatments have failed
25
Q

How do you treat cluster headaches?

A
  • Rarely respond to simple analgesics
  • SUBCUTANEOUS
    SUMATRIPTAN
  • If injection unsuitable, Sumartriptan or Zolmitriptan given as a nasal spray
  • Alternatively can give 100%
    Oxygen to abort attack
25
Q

When is prophylaxis of cluster headaches considered?

A
  • If attacks are frequent, lasting over 3 weeks
  • Or cannot be treated effectively
26
Q

What is given for
prophylaxis of cluster headaches?

A
  1. Verapamil
  2. Lithium
  3. Prednisolone
    - Short term prophylaxis
    - Either monotherapy or in combination with verapamil
  4. Ergotamine tartrate
    - Intermittent basis
    - Alt for pt with short bouts not for prolonged
27
Q

What is the dose of Sumatriptan like?

A
  • Initially 50-100mg for 1 dose
  • Take another 50-100mg after at least 2 hours if required (only if migraine recurs)
  • If the migraine did not respond to the first dose, then they shouldn’t take a second dose to relieve it
  • Maximum 300mg in a day
28
Q

Sumatriptan: Cautions
& Contraindications

A

Not for prophylaxis
Avoid:
- Uncontrolled or severe hypertension
- MI
- IHD
- PVD
- Stroke

Caution
- hepatic
- renal
- epilepsy

29
Q

Can Sumatriptan be used in elderly?

A

unlicensed over 65

30
Q

Sumatriptan - SE

A
  • N&V
  • Disturbances of sensation (include tinglings)
  • Dizziness
  • Drowsiness
  • Flushing
  • Warm sensation
  • Feeling of weakness and fatigue
31
Q

What are the danger symptoms for discontinuation of sumatriptan

A

Discontinue if:
- Symptoms of heat
- Heaviness, pressure, or tightness of throat or chest occurs (signs of cardiac disease e.g. MI)

32
Q

Interactions

A
  • MAOI (either current or within the last 2 weeks)
  • Ergotamine (take 24 hours before or 6 hours after
    sumatriptan)
  • St johns wort (may increase serotonin levels)
  • SSRI or SNRI (causing serotonin syndrome)
  • TCAs (Clomipramine and
    Imipramine)
33
Q

Driving

A
  • Sumatriptan can make you drowsy
  • Avoid driving and operating machinery
34
Q

Sumatriptan: SS

A
  • SSRIS or SRNIS
  • TCAs (ONLY Clomipramine and Imipramine. NOT Amitriptyline)
  • Methadone
  • Mirtazipine
  • Venlafaxine (SRNI)
  • Ondansetron
35
Q

Can you give sumatriptan in pregnancy or breastfeeding?

A

Pregnancy:
AVOID, unless the benefits outweighs the risks
Breastfeeding:
Do not breastfeed for 12 hours after taking sumatriptan

PR - CNS (61 decks)

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