NEURO - Headache Flashcards
What’s the difference between 1˚ and 2˚ headaches?
1˚ - migraines, tension-type headaches, cluster headaches, etc
2˚ - caused by other etiologies (post-traumatic, vascular disease, intracranial pressure, neoplasm, substances, infections)
What 3 pathophysiological processes occur during migraines?
1 - cortical electromagnetic waves (excitation followed by depression) that begins in the occipital lobe and moves anteriorly (why migraines are characterized by visual auras)
2 - stimulation of trigeminal system leads to release of neuropeptides onto the blood vessels, which lead to
a) vasodilation (which causes headaches)
b) inflammation/irritation of the blood vessels (which induces head pain, throbbing corresponds with pulses)
3) oligemia (reduced blood flow observed during the migraine process
Severe migraine attacks are often accompanied by these 3 symptoms:
How do these symptoms affect the treatment?
vomiting
nausea
gastric dysfunction
use non-oral routes to administer migraine therapy because of the vomiting.
Use anti-nausea medication to ease nausea, restore GI motility, and enhance absorption of medications
Chronic treatment with and abrupt withdrawal of analgesics can result in this type of phenomenon:
analgesic rebound - chronic administration and exposure of analgesics results in changes in the receptor levels and can result in a headache if the analgesic is stopped abruptly.
common with aspirin, less common with nsaids
What is the purpose of migraine prophylaxis?
- impede cortical spread of depression
- reduce trigeminal nerve activation
- reduce vasodilation and inflammation
What are the indications for migraine prophylaxis?
headache frequency >2/week overuse of acute medications (analgesic rebound) refractory to acute medications disability/poor quality of life fear of getting headaches (cephalgiaphobia) hemiplegic migraines prolonged auras migranous strokes
What are some non-specific treatments for headaches/migraines?
aspirin, caffeine, NSAIDs (indomethacin, ketorolac, ibuprofen, naproxen)
What migraine medications can be used during pregnancy?
acetominophen/nsaids (except 3rd trimester) opioids (oxycodone, B; morphine, C) metoclopraminde (B) SSRIs Ca blockers
What are tension type headaches? How would you treat episodic attacks? What about prophylaxis treatment?
diffuse, mild - moderate pain that is often described as feeling like a tight band around the head
Episodic attacks: OTC - NSAIDs, Aspirin Prophylaxis: TCAs B-blockers Valproic acid
What are cluster type headaches? How would you treat episodic attacks? What about prophylaxis treatment?
periodic headaches that cause excruciatingly severe unilateral pain; cyclical in pattern (occurs with a predictable frequency; goal of prophylaxis treatment is to break the cycle)
acute:
- sumatriptan, dihydroergotamine/DHE (both are serotonin receptor agonists)
- anti-emetics (parenteral)
- lidocaine (intranasal)
prophylaxis: corticosteroids Ca channel blockers (verapamil, amlodipine, diltiazem) Lithium Depakote
What are status migrainosis? How would you treat episodic attacks? What about prophylaxis treatment?
debilitating migraine headache lasting for more than 72 hours
treatment
- dihydroergotamine (DHE)
Which migraine Rx causes tingling in hands and feet?
topiramate (topomax)
- causes tingling in hands and feet because the drug causes acidosis and that’s how nerves respond
Topiramate = Topomax = Tingling
(this Rx is usually for migraines)
Low doses of this migraine Rx can result in tremors
Lithium
this Rx is usually for cluster headaches
This migraine Rx is largely avoided due to severe vasoconstriction that can lead to MI.
This other migraine Rx also leads to vasoconstriction and can worsen prinzmetal angina (vasospasms)
MI: Dihydroergotamine (DHE)
PMA: Sumatriptan
Note: both are serotonin receptor agonists
This migraine Rx can lead to reduced sexual dysfunction and weight gain.
What is an alternative to this drug?
TCAs (amitriptyline, Nortriptyline); does not happen at low doses
alternative: bupropion
