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Neuro 2 (Mo) > Managementof Headaches > Flashcards

Managementof Headaches Flashcards

1
Q

In general…

A

AVOID TRIGGERS

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2
Q

Serotonin & NSAIDS can

A

Prevent and Treat HA

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3
Q

Role of Spreading Cortical Depression:

self-propagating wave of neuronal and glial depolarization hypothesized to:

A

Cause the aura of migraine

Activate trigeminal afferents

Alter BBB permeability via changes in metalloproteinases

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4
Q

Role of Trigeminovascular System

A

sensory neurons that project to cerebral and pial vessels and to dura mater

activation–> Release peptides–> neuroinflammation–> vasodilate–> Pain

Inflammation has role in prolongation and intensification of migraine pain (sensitization)

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5
Q

Role of Sensitization

A

likely responsible for many migraine clinical symptoms

Throbbing quality of pain
Worsening of pain with coughing-bending-sudden head movements
Hyperalgesia
Allodynia

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6
Q

Role of Serotonin (5-HT)

A

Agonists of 5HT receptors important component in acute treatment - BUT role in generation of migraine unclear

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7
Q

Medication Overuse Headache

A

Can lead to tension HA by using too much analgesics

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8
Q

activation–> Release peptides–> neuroinflammation–> vasodilate–> Pain

A

Trigeminovascular System

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9
Q

PathoPhys Migraine

A

Trigeminal Neurovascular Dysfunction–>

** Trigeminal Neurovascular Activation–>

** Release of Vasoactive Peptides–>

  • Neuroinflammation (including PG release)
    • Vasodilation of Pial and Dural Vessels–>

Moderate to Severe Pain

  • TARGET of NSAID analgesics
    • TARGET of triptans-ergot alkaloids [5HT 1B-1D agonists]
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10
Q

Triptans

A

are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches.

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11
Q

Trigeminal Neurovascular Dysfunction–>

** Trigeminal Neurovascular Activation–>

** Release of Vasoactive Peptides–>

  • Neuroinflammation (including PG release)
    • Vasodilation of Pial and Dural Vessels–>

Pain

  • TARGET?
A
  • TARGET of NSAID analgesics
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12
Q

Sumatriptan

A

Triptans

MOA in Migraine: 5HT1B/D Agonist

Cerebral vasoconstriction–> reverse dilation-induced HA

Inhibit neuropeptide release–> dec. vasodilation, pain, neuroinflammation

Prevent activation of pain fibers in trigeminal nerves

Aborts attack

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13
Q

Triptans- ADRs

A

Rarely: coronary vasospasm, angina, MI, arrhythmia, stroke, death

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14
Q

Trigeminal Neurovascular Dysfunction–>

** Trigeminal Neurovascular Activation–>

** Release of Vasoactive Peptides–>

  • Neuroinflammation (including PG release)
    • Vasodilation of Pial and Dural Vessels–>

Pain

** TARGET?

A

triptans-ergot alkaloids [5HT 1B-1D agonists]

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15
Q

Triptans- DDIs

A

Additive vasoconstriction with ergot alkaloids

Increased risk of serotonin syndrome** with MAOIs - risk very much less with SNRIs-SSRIs

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16
Q

Triptan vs Ergot

A

Triptan fairly well tolerated

Ergot More toxic - NOT first-line

17
Q

used clinically for the purpose of vasoconstriction (5-HT1 receptor agonists) and in the treatment and alleviation of migraines (w/ caffeine) and Parkinson’s

A

Ergot Alkaloids

Aborts attack

18
Q

Ergot Alkaloids ADRs

A

Serious effects: vascular occlusion and gangrene* (strict dosage limits)

Mediated via α1 adrenergic vasoconstriction

19
Q

Ergot Alkaloid DDIs

A

Severe peripheral ischemia if used with non-selective (β1-β2) beta-blockers

20
Q

Non-Opioid Analgesics[tNSAIDs-Acetaminophen-Celecoxib-Aspirin]

MOA in Migraine

A

Inhibition of COX-2

Interrupts neuroinflammatory pathway initiated by release of CGRP (Calcitonin Gene-Related Peptide)

May be sufficient for migraines of mild-moderate intensity

21
Q

Calcium channel blockers ex

A

verapamil

22
Q

ACEIs ex

A

lisinopril

23
Q

Dihydroergotamine

A

Intranasal-parenteral; rapid and reliable onset

Aborts attack

24
Q

Non-Opioid Analgesics (NSAIDs) ADRs**

A

Generally well tolerated

Should be avoided in patients with acute gastritis, peptic ulcer disease, renal insufficiency, or bleeding disorders

25
Q

Non-Opioid Analgesics (NSAIDs) DDIs**

A

Increased bleeding risk in patients receiving antiplatelet agents (clopidogrel-prasugrel) or anticoagulants (warfarin)

26
Q

Chronic Migraine (>15/mo)

A

Botox

27
Q

Abort HA Attack

A 
NSAIDs
Acetaminophen 
Triptans
Ergots
5HT
28
Q

Prevent HA Attack

A 
AVOID TRIGGER
NSAIDs
anti-htn
anticonvulsant
anti-dep
5HT- Antag
29
Q

Anti-HTN in HA

A

**B-Blocker
ccb
acei

30
Q

Antidepressants in HA

A

TCAD

SSRIs

Neuro 2 (Mo) (25 decks)

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