Flashcards in 18 - Headache in Adults Deck (23):
avoid triggers, rest in dark, quiet room if possible, apply headache to area, headache diary to track everything
What are the max doses of abortive meds to avoid MOH ?
-Simple analgesics < 15 days/month (ibuprofen, acetaminophen, naproxen)
-Opioids or combo meds, triptans, ergots < 10 days/month
se/ of ergots?
flushing, tingling, chest pain
MOA of triptans
5-HT 1B and 1D agonists
-supposed to prevent vasoconstriction
What triptan has fastest onset of action?
What triptan has the slowest onset of action?
naratriptan (max efficacy at 4 hours)
When should a person take a triptan?
at onset of headache pain
*taking at aura may be too early
s/e of triptans?
chest discomfort, fatigue, dizziness, flushing
What can patients use for nausea and vomiting associated with migraines?
-Antiemetic/Prokinetic agents (metoclopramide and domperidone) - these ones are also useful to facilitate absorption of some meds
*best evidence for metoclopramide
-Treat for how long at therapeutic dose before assessing benefit?
What is success defined as?
> 50% reduction in headache frequency or days with headache
If it is deemed beneficial at 2 months, continue for how long?
6-12 months, then consider tapering the dose to assess ongoing need
Do not use ergots within ___ hours of triptan
12 (24 if it's naratriptan)
Do not use triptans within ___ hours of an ergot
List some options for prophylaxis
-Beta blockers (propranolol, metoprolol, nadolol, timolol)
-TCAs (amitriptyline, nortriptyline)
-CCBs (verapamil, flunarizine)
-ACEis (lisinopril) - limited evidence
-Antiepileptics (VPA, topiramate, little evidence for gabapentin)
-Serotonin antagonists (pizotifen at max dose)
What can you use for menstrually associated migraine
use frovatriptan x 5-7 days, starting 2 days before menses
*perimenstrual use of naratriptan or zolmitriptan
When would you consider prophylaxis for a patient?
severity of impact on QOL
failing to respond to abortive therapies
6+ headache days a month
What are some NHPs for prophylaxis?
What is chronic headache defined as?
15 days/month for > 6 months
Treatment for chronic headache or MOH?
stop/taper the abortive meds and consider adding prophylaxis
What meds can we use?
-ibuprofen and naproxen ok during 1st and 2nd trimester
What meds can we use?
-all the nausea meds are safe in breastfeeding (metoclopramide, domperidone, dimeydrinate, prochlorperazine)
-VPA is compatible with breastfeeding