Pharmacologic Treatment of Headaches

Question 1

Which abortive treatments for migraine should be avoided in someone with ischemic vascular disease?

Answer 1

Triptans

Ergots

Question 2

NSAIDs are avoided in those with _________. Why?

Answer 2

acute gastritis; NSAIDs (most) inhibit COX-1, which secretes protective mucus in the stomach

Question 3

Ergots are ____________ treatments.

Answer 3

abortive

Question 4

The vascular events in migraines appear to have two phases: ________________.

Answer 4

first vasoconstriction then vasodilation

Question 5

Drug delivery can be impacted by the tendency to have _____________ with migraines.

Answer 5

nausea, vomiting, or GI dysmotility

Question 6

Do not concurrently use ergots and triptans. Why?

Answer 6

Because their vasoconstrictive effects can be additive

Question 7

What is the mechanism of ergots?

Answer 7

5HT-1b/1d agonist

Question 8

When should you initiate prophylactic treatment for migraines?

Answer 8

When the migraines are frequent (more than four per month), disabling, or long-lasting

Question 9

Which should you use first, triptans or ergots?

Answer 9

Triptans. Ergots have greater toxicity.

Question 10

How long do prophylactic treatments take to become effective?

Answer 10

4-6 weeks