Pharmacology - Headache - Luis Mejico Flashcards
Most migraine auras are last for how long?
5-20 minutes, usually not longer than 60
Most common aura is visual, thought paresthesias can also occur
What kind of headache are we talking about?
Usually unilateral;
throbbing;
moderate to severe pain;
aggravated by physical activity and light;
usually lasts 4-72 hours
Migraine headache
What are the migraine specific medications?
Ergots and triptans
What is status migranosis and what is the treatment?
A severe headache lasting longer than 72 hours;
Treat with IV DHE (dihydroergotamine)
T/F: Triptans are not helpful in treating the aura phase.
True
Triptans should be avoided in patients with what disease?
Vascular disease, uncontrolled HTN, complicated migraine syndromes
Name the side effects of the Triptans.
Flushing, tingling, dizziness, chest discomfort
What is the prodrome of a headache?
Occurs in 20% of migraine sufferers
Can be change in mental status, drowsiness, depression, irritable, hyperactive, euphoric, talkative, phono or photophobic, yawning, difficulty concentrating, dysphoria, anorexia, food craving, thirst, urination, fluid retention, diarrhea/constipation, stiff neck
NSAIDS COX-2 inhibitors Combination analgesics Neuroleptics/antiemetics Corticosteroids Opiods
These drugs all make up what HA treatment?
Acute nonspecific migraine treatment
Should DHE be used in pregnancy for migraine?
No
Why are barbiturate medications not often used for migraine?
Risk of overuse –> rebound headaches
Rebound HA are most common in barbiturate and caffeine containing medications
What is the most common cause of chronic daily HA?
Medication oversue
Why is acetominophen preferred in children for treatment of HA?
Risk of Reye’s syndrome in children with use of other NSAIDS
What are frequent side effects of barbiturates for use in treating HA?
Drowsiness, dizziness,
risk of overuse and withdrawal
Opiods for HA should not be used more than how many days per week?
About 2. About the same with barbiturates
Codeine, meperidine, oxycodone, hydromorphone, morphine, methadone, butorphanol.
What is the transnasal opiod for use in migraine headache treatment?
Butorphanol
Migranal is DHE in nasal spray form but it’s not an opiod.
When are corticosteroids used in migraine headache treatment?
Status migranosis
Oral and parenteral can be used
What is the MOA of Ergotamine?
Reduces cell activity in the trigeminovascular system
What are the adverse reactions associated with Ergotamine (rarely used) and DHE?
Nausea, dizziness, paresthesia, chest pain, abdominal cramps
Ergots should be avoided in what patients?
Pregnant, planning on pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease (cardiac, cerebral, peripheral)
Selective 5-HT 1B-D agonists describes what class of drugs?
Triptans
Premier migraine abortive drug
MOA is to constrict the extracerebral intracranial vessels and inhibiting the trigeminovascular system
What tricyclic antidepressants are recommended for migraine prevention?
Amitryptaline
Protriptaline
Nortriptyline
All are TCAs.
Dry mouth, constipation, weight gain, cardiac toxicity and orthostatic hypotension are AEs
What SSRIs are recommended for migraine prevention?
Fluoxetine
Paroxetine
Sertraline
What beta blockers are recommended for migraine prevention?
Propranolol
Timolol
Nadolol and Atenolol sometimes preferres bc longer half life and tolerability
Beta blockers should not be used in patients with what diseases?
Asthma
Diabetes
CHF
Raynaud’s
What calcium channel blocker is particularly suited for treating the aura phase of migraine prevention?
Verapimil
Helpful in complicated migrane (ie hemiplegic migraine) or prolonged or disabling aura
What are the side effects of Verapimil?
Constipation
Dizziness
What antiepileptic drugs are recommended for migraine prevention?
Valproic acid (Divalproes sodium ER) Topiramate
What are the common side effects of valproic acid?
Sedation, hair loss, weight gain, tremor, changes in cognition
What are common side effects of topiramate?
Changes in cognition
Paresthesias
Weight loss
Serious side effects: acute-closure angle glaucoma, kidney stones
What is the main site of topiramate metabolism?
Kidney
When is onabotulinumtoxinA (Botox) indicated in migraine prevention?
FDA-approved for chronic migraine;
MOA unknown
Recommended when more than 8 of 15 headaches per month are migraines
What are the recommended treatments for chronic tension type headaches?
TCA: Amitriptyline
SSRIs, muscle relaxants, Botox
What is the epidemiology of cluster headaches?
Men more than women (4:1)
27-31 years old
Leonine facies possible in men, masculine-looking women
2 forms: episodic and chronic
O2, Sumatriptan, DHE (SC and intranasal) and lidocaine nasal drops are recommended fast-acting treatments for what kind of headache?
Cluster headache
symptoms come on suddenly
When are steroids like prednisone or methylprenisolone recommended in HA treatment?
Cluster HA, steroids can be used short-term
What is the long-term prevention of cluster HA?
Verapimil
Topiramate
Valproic acid
Lithium
What are the side effects of lithium?
Weakness Nausea Thirst Tremor Lethargy Blurred vision Slurred speech
What medications should be avoided if s patient if on lithium, because they will increase the amount of lithium in the body?
Indomethacin
Sodium-depleting diuretics
