18 - Headache in Adults Flashcards Preview

PEBC > 18 - Headache in Adults > Flashcards

Flashcards in 18 - Headache in Adults Deck (23):
1

non-pharms

avoid triggers, rest in dark, quiet room if possible, apply headache to area, headache diary to track everything

2

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

3

se/ of ergots?

flushing, tingling, chest pain

4

MOA of triptans

5-HT 1B and 1D agonists
-supposed to prevent vasoconstriction

5

What triptan has fastest onset of action?

SC sumatriptan

6

What triptan has the slowest onset of action?

naratriptan (max efficacy at 4 hours)

7

When should a person take a triptan?

at onset of headache pain

*taking at aura may be too early

8

s/e of triptans?

chest discomfort, fatigue, dizziness, flushing

9

What can patients use for nausea and vomiting associated with migraines?

-Antinauseants (dimenhydrinate)
-Antiemetic/Prokinetic agents (metoclopramide and domperidone) - these ones are also useful to facilitate absorption of some meds

*best evidence for metoclopramide

10

Prophylactic Therapy:
-Treat for how long at therapeutic dose before assessing benefit?

2 months

11

Prophylactic Therapy:
What is success defined as?

> 50% reduction in headache frequency or days with headache

12

Prophylactic Therapy:
If it is deemed beneficial at 2 months, continue for how long?

6-12 months, then consider tapering the dose to assess ongoing need

13

Do not use ergots within ___ hours of triptan

12 (24 if it's naratriptan)

14

Do not use triptans within ___ hours of an ergot

24

15

List some options for prophylaxis

-Beta blockers (propranolol, metoprolol, nadolol, timolol)
-TCAs (amitriptyline, nortriptyline)
-SNRIs (venlafaxine)
-CCBs (verapamil, flunarizine)
-ACEis (lisinopril) - limited evidence
-ARBs (candesartan)
-Antiepileptics (VPA, topiramate, little evidence for gabapentin)
-Serotonin antagonists (pizotifen at max dose)
-Lithium
-Botox

16

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

17

When would you consider prophylaxis for a patient?

>3 migraines/month
severity of impact on QOL
failing to respond to abortive therapies
6+ headache days a month

18

What are some NHPs for prophylaxis?

magnesium
riboflavin
coenzyme Q10
butterbur

19

What is chronic headache defined as?

15 days/month for > 6 months

20

Treatment for chronic headache or MOH?

stop/taper the abortive meds and consider adding prophylaxis

21

Pregnancy:
What meds can we use?

-acetaminophen
-ibuprofen and naproxen ok during 1st and 2nd trimester

22

Breastfeeding:
What meds can we use?

-acetaminophen
-ibuprofen
-sumatriptan
-all the nausea meds are safe in breastfeeding (metoclopramide, domperidone, dimeydrinate, prochlorperazine)
-VPA is compatible with breastfeeding

23

Breastfeeding:
What is preferred for prophylaxis?

propranolol and magnesium

Decks in PEBC Class (130):