Treatment of headaches Flashcards

Question

Prophylactic agents: BOTOX:

Answer 1

Prophylaxis - Migraine (Chronic) • Multiple injections given in head/neck muscle areas • Mechanism: blocks neuromuscular conduction by binding to receptor sites on motor nerve terminals, entering the nerve terminals, and inhibiting the release of acetylcholine. When injected intramuscularly in therapeutic doses, causes muscle paralysis

Answer 2

a) Taken just before a migraine attack or as soon as possible after onset of migraine attack b) Nonspecific agents that treat pain and are used to abort a migraine attack include: i. INSAIDS, Ibuprofen, naproxen, acetaminophen, ketorolac ii. Mild to Moderate Migraine: Acetaminophen, Aspirin, ibuprofen, naproxen. Combinations of acetaminophen, aspirin and caffeine can also help iii. Moderate to Severe Migraine: Ketorolac (IV or oral) use for a max 5 days iv. Children: Acetaminophen and ibuprofen v. Pregnant women: Ibuprofen and acetaminophen can be used in pregnancy. *All NSAIDs should be avoided in the last trimester due to increased bleeding and premature closure of the ductus

Answer 3

i. Ergotamine and Dihydroergotamine ii. Used for moderate to severe migraine attacks and can be combined with an antiemetic to curve nausea iii. *They are rescue agents that are not used for prophylactic therapy iv. Mechanism: The anti-migraine activity of ergot alkaloids are likely to be attributed their agonist effects at 5-HT1 receptors, however they also have partial agonist and antagonist activity at serotonergic, dopaminergic and adrenergic receptors

Answer 4

v. Routes of administration: Ergotamine sublingual (extensive first pass effect). Dihydroergotamine: nasal spray, or injection (sc, im, or iv) vi. **Side effects: Nausea and vomiting induced by Ergots are a problem given that nausea and vomiting are associated with migraine. Significant generalized vasoconstriction can also be a significant problem (Myocardial infarction, Peripheral ischemia, Vasoconstriction, Coronary, Vasospasm). Ergots cannot be used in pregnancy (Pregnancy X drug) they may cause fetal stress and miscarriage. vii. **Contraindicated in: (1) pregnancy (2) peripheral vascular disease (tingling, peripheral vasoconstriction) (3) Ischemic Heart Disease because can induce angina, coronary vasospasms viii. *Cannot be used in combination with Triptans (must have 24 hr delay).

Answer 5

i. There are several Triptans including Sumatriptan, Rizatriptan, Zolmitriptan, Naratriptan and Frovatriptan ii. Triptans are used to abort a migraine attack and they are not used for migraine prophylaxis iii. *Triptans cause significantly less nausea and generalized vasoconstriction as compared to the Ergot alkaloids iv. Triptans have a more selective mechanism of action relative to the Ergots given that they are selective 5-HT1B/1D Receptor Agonists v. *Antimigraine Mechanisms of the 5-HT1B/1D Receptor Agonists

Answer 6

Vascular: Vasoconstriction of cranial vessels Neurogenic: Reduction of trigeminal sensory nerve activation and inhibition of vasoactive neuropeptide release Central: Inhibition of neurotransmitter release from activated trigeminal nerves in the brainstem and upper cervical spinal column

Answer 7

• Prototype triptan and has a short onset and short duration of action. • Administered subcutaneously, orally or via nasal spray and provides relief within approximately 1 hr and has a half-life of 2 hrs. • Onset of action for SQ

Answer 8

• Given orally, onset of action of approximately 1hr • Lipophilicity may result in greater distribution to the brain stem. • Greater bioavailability (70%) relative to sumatriptan (15%) • More effective then sumatriptan with a lower instance of recurring headaches. • Longer duration of action (half-life of 6 hrs) compared to sumatriptan • P450 metabolism and 50% of drug excreted in urine unchanged • Lower dose in renal dysfunction

Answer 9

longest acting Triptan (half-life of more than 24 hrs). Highest affinity for 5-HT1B/1D receptor. Slower unset to action than other triptans.

Answer 10

Available as quick dissolving tablet (sublingual) • Rapid onset of action, high bioavailability, Faster onset than sumatriptan • Less nausea than sumatriptan • Half-life 2 hrs • Metabolism MAO

Answer 11

Adverse effects • * Headache Recurrence • Tingling, paresthesia, dizziness, flushing, neck pain and drowsiness Contraindications • Use of ergot alkaloid within 24 hrs • peripheral vascular disease • ischemic heart disease

Answer 12

Should avoid concurrent use with Serotonin Selective Reuptake Inhibitors as it could induce serotonin syndrome that manifests as restlessness, hallucinations, loss of coordination, diarrhea

Answer 13

``` 1.Episodic severe unilateral stabbing headaches that tend to appear at the same time each (circadian rhythm) 2.Acute Treatments for cluster headache attack include: a) Oxygen b) Triptans (rapid onset Triptans) 3.Prophylactic a) High dose prednisone b) Calcium channel Blockers (Verapamil) ```

Answer 14

1.Headache pain is a squeezing sensation or pressure felt around the head that is not associated with nausea or vomiting. a) Abortive medications • Acetaminophen and NSAIDS b) Prophylactic medications include: tricyclic antidepressants such as amitriptyline and the antiepileptic gabapentin

Answer 15

1. Pain due to increases in intracranial pressure and the disorder occurs most frequently in obese young women 2. Treatments include weight loss and removal of drugs that could be responsible for IIH (including: tetracycline containing drugs, oral contraceptives and hypervitaminosis) 3. Drug therapy includes the use of carbonic anhydrase inhibitors: a) *Acetazolamide and Topiramate b) Mechanisms: Function as carbonic anhydrase inhibitors that reduce CSF production c) Side effects: nausea, fatigue, tingling in the hands and feet and altered taste, distal paresthesia, concentration difficulties and weight loss