Pharm Wk 12 - Headaches Flashcards
What are the 3 most common headache disorders?
- tension-type headache
- migraine
- medication-overuse headache
What is the primary goal of headache therapy?
To relieve or abolish pain and associated symptoms (e.g., nausea and vomiting), prevent recurrence, and manage serious causes.
What are red flags for serious causes of headaches?
Sudden onset, changes in consciousness, mental status, or vision, fever, one-sided weakness, significant change in headache pattern.
What is the goal of acute headache therapy?
To achieve rapid freedom from pain and associated symptoms without recurrence.
What should be considered when treating headaches with antiemetics?
Antiemetics (e.g., metoclopramide) are helpful for nausea and vomiting, and can aid in the absorption of medications.
What is the first-line analgesic treatment for headaches?
ASA and NSAIDs (e.g., naproxen, ibuprofen) due to their anti-inflammatory properties.
What are the adverse effects of NSAIDs?
Increased cardiovascular risk, GI upset, ulceration, and chronic use can lead to medication-overuse headache.
What is the mechanism of action of dihydroergotamine (DHE)?
It targets serotonin receptors, causing vasoconstriction of cranial blood vessels, reducing dilation and alleviating pain.
What are the contraindications for DHE use?
Pregnancy, cardiac disorders, hypertension, sepsis, liver disease, peptic ulcer disease, renal disease.
What are triptans used for?
Triptans are used for acute migraine relief, particularly when taken early during an attack.
What is the most effective triptan?
Sumatriptan.
What are common side effects of triptans?
Chest discomfort, fatigue, dizziness, paresthesia, drowsiness, nausea, throat symptoms.
What is the mechanism of action of calcitonin gene-related peptide receptor antagonists (CGRP-RA)?
CGRP is involved in pain transmission, and blocking it helps reduce migraine-related pain.
What is a major risk of using CGRP-RA?
Increased risk of cardiovascular or cerebrovascular ischemic events.
What is the effect of medication-overuse headache (MOH)?
It typically improves weeks to months after discontinuation of the offending medication.
What is the goal of prophylactic therapy for headaches?
To reduce attack frequency, severity, and disability, and improve quality of life.
What are common drug options for prophylactic therapy?
Beta blockers, TCAs, angiotensin receptor blockers, antiepileptics, CGRP monoclonal antibodies.
What are the most common side effects of beta blockers?
Fatigue, bradycardia, hypotension, GI symptoms, bronchospasm, heart failure, depression.
What is amitriptyline used for in headache therapy?
It is used for tension-type headaches and works as a prophylactic therapy.
What are the side effects of topiramate?
CNS effects (e.g., dizziness, ataxia), GI symptoms, weight loss, cognitive impairment, increased risk of nephrolithiasis.
What is the primary use of gabapentin in headache therapy?
Gabapentin is used to prevent headaches and is often helpful for comorbid insomnia.
What is the role of CGRP monoclonal antibodies in headache management?
They are used as a preventative therapy after first-line treatments fail.
How is erenumab administered?
By monthly subcutaneous injection.
What are the considerations for headache treatment during pregnancy?
Acetaminophen is the preferred agent, and preventive and acute medications should be discontinued before conception.
What is the role of lactation in migraine management?
Lactation may have a positive effect on migraine activity, and it is encouraged during breastfeeding.
What is the preferred acute treatment for headaches in children and adolescents?
Ibuprofen is preferred over acetaminophen, and ASA should be avoided due to the risk of Reye’s syndrome.
What is the role of antiemetics in headache management in children?
Antiemetics like metoclopramide can be effective for nausea and migraine relief in children.
What is the only triptan approved for use in children aged 12–18?
Almotriptan.
What prophylactic medications are recommended for children with migraines?
Propranolol, topiramate, and amitriptyline.
Why is propranolol favored for pediatric migraine prophylaxis?
It does not appreciably pass into breast milk and is well-tolerated in children.
