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
