Headache

Question 1

Tension headache

Answer 1

• idiopathic (may be related to migraines). Can be confused with mild migraines.
• Steady, aching pain, generalized, with tender muscles. anxiety/depression/stress
• Tx: eliminate causal factors (anxiety/depression). NSAIDs, acetaminophen, aspirin. If severe, migraine drugs may be useful.

Question 2

Cluster HA

Answer 2

• rare – middle age men
• Subtypes: Episodic (2-3 mos w remission) Chronic (1-2 yrs, no remission)
• Severe periorbital pain (unilateral) with lacrimation, flushing, nasal drainage
• Worse w EtOH and sleep
• Tx: sumatripan/O2 for acute attacks. Prophylax with Verapamil. (Ergotamine, methysergide, Li, prednisone are alternatives). Respond well to prophylaxis!

Question 3

Tx Migraine

Answer 3

Abortive (can cause rebound HA):

• Mild: NSAIDs or acetaminophen.
• If fail, DHE or a triptan

Prophylaxis (daily):

• consider in pts with weekly episodes.
• First line: TCAs (amitriptyline), propanolol (most effective)
• Second line: Verapamil (CCB), VPA, Methysergide

Question 4

Tx Menstrual migraines

Answer 4

NSAIDS are most effective

Question 5

Dihydroergotamine (DHE)

Answer 5

• 5-HT1 agonist
• highly effective for abortive Tx
• SC, IM, IV, or nasal admin
• Contraindicated: CAD, pregnancy, TIAs, PVD, sepsis

Question 6

Sumatriptan

Answer 6

• Most selective 5-HT1 agonist
• 1 hr onset, highly effective
• should not be used >1-2x/week
• Contraindicated: CAD, pregnancy, uncontrolled HTN, basilar artery migraine, hemiplegic migraine, use of MAOI, SSRI, or Li

Question 7

what to do if migraine pt fails abortive Tx

Answer 7

-work em up! Unlikely to be migraine