Pharm Wk 12 - Headaches

Question 1

What are the 3 most common headache disorders?

Answer 1

• tension-type headache
• migraine
• medication-overuse headache

Question 2

What is the primary goal of headache therapy?

Answer 2

To relieve or abolish pain and associated symptoms (e.g., nausea and vomiting), prevent recurrence, and manage serious causes.

Question 3

What are red flags for serious causes of headaches?

Answer 3

Sudden onset, changes in consciousness, mental status, or vision, fever, one-sided weakness, significant change in headache pattern.

Question 4

What is the goal of acute headache therapy?

Answer 4

To achieve rapid freedom from pain and associated symptoms without recurrence.

Question 5

What should be considered when treating headaches with antiemetics?

Answer 5

Antiemetics (e.g., metoclopramide) are helpful for nausea and vomiting, and can aid in the absorption of medications.

Question 6

What is the first-line analgesic treatment for headaches?

Answer 6

ASA and NSAIDs (e.g., naproxen, ibuprofen) due to their anti-inflammatory properties.

Question 7

What are the adverse effects of NSAIDs?

Answer 7

Increased cardiovascular risk, GI upset, ulceration, and chronic use can lead to medication-overuse headache.

Question 8

What is the mechanism of action of dihydroergotamine (DHE)?

Answer 8

It targets serotonin receptors, causing vasoconstriction of cranial blood vessels, reducing dilation and alleviating pain.

Question 9

What are the contraindications for DHE use?

Answer 9

Pregnancy, cardiac disorders, hypertension, sepsis, liver disease, peptic ulcer disease, renal disease.

Question 10

What are triptans used for?

Answer 10

Triptans are used for acute migraine relief, particularly when taken early during an attack.

Question 11

What is the most effective triptan?

Answer 11

Sumatriptan.

Question 12

What are common side effects of triptans?

Answer 12

Chest discomfort, fatigue, dizziness, paresthesia, drowsiness, nausea, throat symptoms.

Question 13

What is the mechanism of action of calcitonin gene-related peptide receptor antagonists (CGRP-RA)?

Answer 13

CGRP is involved in pain transmission, and blocking it helps reduce migraine-related pain.

Question 14

What is a major risk of using CGRP-RA?

Answer 14

Increased risk of cardiovascular or cerebrovascular ischemic events.

Question 15

What is the effect of medication-overuse headache (MOH)?

Answer 15

It typically improves weeks to months after discontinuation of the offending medication.

Question 16

What is the goal of prophylactic therapy for headaches?

Answer 16

To reduce attack frequency, severity, and disability, and improve quality of life.

Question 17

What are common drug options for prophylactic therapy?

Answer 17

Beta blockers, TCAs, angiotensin receptor blockers, antiepileptics, CGRP monoclonal antibodies.

Question 18

What are the most common side effects of beta blockers?

Answer 18

Fatigue, bradycardia, hypotension, GI symptoms, bronchospasm, heart failure, depression.

Question 19

What is amitriptyline used for in headache therapy?

Answer 19

It is used for tension-type headaches and works as a prophylactic therapy.

Question 20

What are the side effects of topiramate?

Answer 20

CNS effects (e.g., dizziness, ataxia), GI symptoms, weight loss, cognitive impairment, increased risk of nephrolithiasis.

Question 21

What is the primary use of gabapentin in headache therapy?

Answer 21

Gabapentin is used to prevent headaches and is often helpful for comorbid insomnia.

Question 22

What is the role of CGRP monoclonal antibodies in headache management?

Answer 22

They are used as a preventative therapy after first-line treatments fail.

Question 23

How is erenumab administered?

Answer 23

By monthly subcutaneous injection.

Question 24

What are the considerations for headache treatment during pregnancy?

Answer 24

Acetaminophen is the preferred agent, and preventive and acute medications should be discontinued before conception.

Question 25

What is the role of lactation in migraine management?

Answer 25

Lactation may have a positive effect on migraine activity, and it is encouraged during breastfeeding.

Question 26

What is the preferred acute treatment for headaches in children and adolescents?

Answer 26

Ibuprofen is preferred over acetaminophen, and ASA should be avoided due to the risk of Reye’s syndrome.

Question 27

What is the role of antiemetics in headache management in children?

Answer 27

Antiemetics like metoclopramide can be effective for nausea and migraine relief in children.

Question 28

What is the only triptan approved for use in children aged 12–18?

Answer 28

Almotriptan.

Question 29

What prophylactic medications are recommended for children with migraines?

Answer 29

Propranolol, topiramate, and amitriptyline.

Question 30

Why is propranolol favored for pediatric migraine prophylaxis?

Answer 30

It does not appreciably pass into breast milk and is well-tolerated in children.