Pharmacological treatment of Headache Disorders Flashcards
What are non specific drugs to stop a migraine
NSAIDs, Corticoseteroids, analgesics, antiemetic’s
What are migraine specific drugs
Triptans and Ergots
What analgesic would be used to treat a migraine, what combo analgesic would be used
Acetaminopehn 325- 1000mg every 4 to 6 hours as needed/ Excedrin 2 tables every 6 hours as needed
What NSAIDs would be used to treat a migraine
Ibuprofen: 200-800 mg every 6 hours as needed, Aspirin 500- 1000 mg every 4 to 6 hours as needed, Naproxen: 550-825 mg at onset then 220 mg every 3 to 4 hours as needed, Diclofenac: 50-100mg at onset then 50 mg in 8 hours as needed
T/F: Opiates have great used in migraines
False: Generally not recommended due to no anti-inflmmatory effect due to central desentizitation
Which antiemetic agents are used for migraines, when are they given
Metoclopramide, chlorpromazine, prochlorperazine/ administer 15-30 minutes before abortive treatment
When are Ergot alkaloids used in migraines, MOA
acute therapy for moderate to severe migraine/ vasoconstriction of meningeal vessels and inhibit vasoactive neuropeptide release
What are the two types of ergot alkaloids, formulations, what are the Adverse effects, which is non to have dose restrictions to prevent rebound headaches
- Ergotamine tartrate (with caffeine enhance GI absorption)
- oral, rectal, sublingual
- Dihydroergotamine (sometimes mixed with lidocaine)
- IV, IM, SC
AEs: nausea, vomiting, abdominal pain, weakness/fatigue, diarrhea
Ergotamine tartrate
T/F: Ergots should not be used within 12 hours of any triptan
False: Ergots should not be used within 24 hours of any triptan
What is a rare but severe adverse effect of ergot alkaloids, what contraindications must be avoided to prevent this
Ergotism: peripheral iscemia due to vasoconstriction characterized by cold, numb, painful extremities, and diminished peripheral pulses
- Coronary artery disease
- Cerebrovascular disease
- Peripheral vascualr disease
- Uncontrolled hypertension
- Pregnant or nursing
- CYP 3A4 inhibitors (clarithromycin, azithromycin, erythromycin, ketoconazole/ protease inhibitors)
When are triptans used, therapeutic pharmacologic actions
Mild to severe migraines during an aura,
- vasoconstriction of intracranial blood vessels
- inhibition of vasoactive neuropeptide release
- interruption of pain signal transmissions
What are contraindications of triptans
- Coronary artery disease
- Cerebrovascular disease
- Peripheral vascular disease
- Severe liver disease
- Uncontrolled hypertension
What patients can take triptans but do have caution when recieving them
- Men older than 40, women older than 55
- Taking antidepressants (serotonin syndrome)
- have diabetes
- family history of heart disease or stroke
- high cholesterol
- menopause/pregnant
- obese
- Smoke
What is Triptan sensation
Chest, arm, and jay pain following triptan use (similar to a heart attack)
What are the short duration triptans
Sumatriptan, almotriptan, eletriptan, rizatriptan, zolmitriptan
What are the long duration triptans
naratriptan and frovatriptan
Which triptans have the shortest onset (15-20 mins), which have nasal formulations
sumtraiptran and zolmitriptan
Which triptans are have oral disentegrating tablet formulations
Rizatriptan and Zolmitriptan
Which triptans are mostly eliminated renally
naratriptan and frovatriptan
Which triptans are mostly metabolized by CYP3A4
almotriptan and eletriptan
Which triptans are metabolized by CYP1A2
frovatriptan and zolmitriptan
Which triptans are metabolized by MAO-A
rizatriptan and sumatriptan
T/F: Triptans should be used for 3 to 4 headaches before a different triptan is used
True
Which medications are used to mask migraines but NOT treat
- acetaminophen compounds (codeine, hydrocodone)
- Opiods
- baclofen
- Ondansetrone
- Butalbital products
What beta-blockers can be used as prophlatic therapy for migraines, Adverse effects
- Metoprolol, Propanolol, and Timolol
- AE: drowsiness, fatigue, vivid dreams, bradycardia, hypotension
MUST BE TITRATED
Which antidepressants can be used in prophylactic therapy, anticonulsants, whicc class should not be used in pregnant pateints
- Amitriptyline and Venlafaxine
- Topiramate, Divalproex, Valporic acid
Anticonvulsants
Which OTCs have shown efficacy against migraines
- Magnesium Oxide
- migraines with aura, menstrual migraines
- Feverfew
- withdrawal may increase headaches
- Riboflavin
- Benefit only after 3 months
- Petasites
- use only commercial preparations
What injection is indicated for chronic migraines only
Botox
What do certain monoclonal antibodies target in order to reduce migraines, what are they, benefits, what must be accomplished before they patients qualify
CGRP ligands or CGRP receptors
- Erenumab (receptor)
- Fremanezumab (ligand)
- Glacanezumab (ligand)
No need to titratrate, dose monthly or quarterly, minimal to no side effects or DDIs, specific for migraine prophylaxis
Must fail 2 prophylactic meds
Which medications are used to treat tension-type headaches
NSAIDs, Analgesics, Combination analgesics, Fioricet (butalbital, caffeine and acetaminophen), Fiorinal (butalbital, aspirin, caffeine)
What drugs can be used as prophylaxis of tension-type headaches
Amitriptyline
What drugs are used to treat cluster headaches
- Oxygen 12L/min every 15 min
- Sumatriptan
- Zolmitriptan
- Galcanezumab
Which drugs can be used for prophylaxis of cluster headches
- Prednisone
- Verapamil (EKG should be checked for heart block)
- Lithium
How long does detoxification take for patients with medication overuse headaches,
1-3 months
