Headaches

Question 1

First line treatments for tension headaches include _____ and _____. They should be taken no more than ______ a week

Answer 1

ASA
APAP
2 days a week

Question 2

Second line treatments for TTH (tension type headaches) include _______.

Answer 2

Aleve

Advil

Question 3

If a second line treatment for headache, such as Aleve or Advil, fails after ______ consecutive headaches, then____

Answer 3

two
another agent of this class should be tried

Question 4

If second line treatments for TTH provide incomplete relief, ____ may help

Answer 4

antiemetics

Question 5

Another effective second line treatment for TTH that can be bought over the counter is _____ which contains ____

Answer 5

Excedrin Extra Strength

Caffeine

Question 6

Third line therapy for TTH, ______ containing agents, such as ______. These should be used no more than_____

Answer 6

Butalbital
Fioricent (Fiorinal)
3 times a month

Question 7

If a patient has more that ____ TTH per week, or severe TTH can be given prophylactic ____

Answer 7

two

antidepressants

Question 8

Three antidepressants used for prevention of severe or persistent TTH are

Answer 8

Amitriptyline (Elavil)
Venlafaxine XR (Effexor)
Mirtazapine (Remeron)

Question 9

a major adverse effect of antidepressant use is

Answer 9

increased suicide risk in young adults (18-24), adolescents and children

Question 10

Amitriptyline (Elavil)

Answer 10

TCA
depression, migraine prophylaxis, eating disorder
serotonin and norepinephrine reuptake inhibitor, anticholinergic
suicide risk
take before bed to reduce daytime sleepiness, may take up to 4 weeks to see full effect

Question 11

Venlafaxine (Effexor)

Answer 11

antidepressant, SNRI
depression, generalized anxiety, headache prophylaxis
**suicide risk in children, adolescents and young adults
**do not administer with monoamine oxidase inhibitors (MAOI)
**angle closure glaucoma risk

Question 12

Mirtazapine (Remeron)

Answer 12

antidepressant
**reduced renal and hepatic clearance
adverse effects: somnolence, weight gain, xerostomia
**suicide risk

Question 13

First line treatments for migraine headaches include ____ and ____. OTC medicines including____ such as ____ are also effective

Answer 13

NSAIDs and ASA
caffeine
Excedrin

Question 14

Second line treatment for migraine type headaches are the ___

Answer 14

Triptans (Serotonin 5-HT1 agonists)

Question 15

The pathophysiology of headaches is thought to be ____, therefore triptans, a migraine specific drug, work by ____, and are contraindicated in

Answer 15

vasodilation
vasoconstriction

pregnancy, ischemic heart disease, CAD, uncontrolled HTN
within 24 hrs of ergotamine containing medications
within 2 weeks of MAOI
serotonin syndrome risk

**Renal and hepatic adjustment

Question 16

Seven examples of Triptans (5 HT1 agonists) are 
\_\_
\_\_
\_\_
\_\_
\_\_
\_\_
\_\_

Answer 16

Sumatriptan (Imitrex) 
Zolmitriptan (Zomig) 
Naratriptan (Amerge) 
Rizatriptan (Maxalt) 
Almotriptan (Axert) 
Eletriptan (Relpax) 
Frovatriptan (Frova)

Question 17

Although less safe than the second line treatment for migraines, the ____, the drug class ______ is the third line treatment for migraine headaches.

Answer 17

triptans

ergot derivatives

Question 18

Ergotamine warnings

Answer 18

may cause ischemia to hands, feet and brain
contraindicated in CAD and PVD
may cause severe nausea and vomiting

Question 19

If migraine specific medications have failed, ____ can be used

Answer 19

Butalbital containing agents (Fioricet, Fiorinal)

Question 20

Two classes of drugs that can be used as rescue medications for migraine headache include ___ and ___

Answer 20

Opioids and steroids

Question 21

An example of a steroid for a severe, persistent migraine refractory to abortive treatment is ___

Answer 21

a five-day course of 6mg of dexamethasone, until the pt headache free for 24 hrs

Question 22

Abortive agents for headache may be augmented by ____

Answer 22

anti-emetics

Question 23

Three examples of antiemetic agents are ___, ___ and ___

Answer 23

Prochlorperazine (Compazine) –comes in suppository form
Metoclopramide (Reglan)
Droperidol (Qt prolongation, Torsade de pointes)

Question 24

Two major side effects of Droperidol are ___ and ___

Answer 24

QT prolongation and Torsade de pointes

Question 25

Several prophylactic medications for migraine headaches come from these drug classes: ________________________________

Answer 25

Beta-blockers
TCA 
Anticonvulsants 
MAOIs 
Calcium channel blockers
Gabapentin 
SSRIs

Question 26

Examples of betablockers for the prevention of migraine headaches are

Answer 26

Propranolol

Timolol

Question 27

Examples of Tricyclic antidepressants for prevention of migraine headache are

Answer 27

Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor)

Question 28

Examples of anticonvulsants used for migraine prophylaxis are

Answer 28

Depakote -hepatic dosing

Topiramate -renal dosing

Question 29

Patients experiencing cluster headaches should be___

Answer 29

immediately referred to neuro to exclude potentially serious differential diagnoses

Question 30

Cluster headaches can be treated with _________, and prevented by_____

Answer 30

SQ Sumatriptan, intranasal Sumatriptan, Zolmitriptan nasal spray, and 15-30min/daily 100% nonrebreather oxygen
SQ octreotide, olanzapine, intranasal lidocaine

Verapamil, Lithium, Topiramate, Gabapentin, valproic acid, leuprolide, intranasal capsaicin, and baclofen