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Pharmacology II > Headache > Flashcards

Flashcards in Headache Deck (25):
1

#1 cause of daily headache

medication-overuse headache or Rebound headache

2

Which medications are typically to blame for rebound headache?

1. Simple and combo analgesics
2. Opiates

-Limit acute migraine therapy to fewer than 10 days a month**

3

Migraine patho

-neuropeptide release leads to dural blood vessel vasodilation
-neurogenic inflammation
-trigeminal pain fibers transmit pain

4

Long term goals of migraine treatment

-Reduce disability
-Improve quality of life
-Avoid escalation of headache medication use

5

Goals for acute migraine treatment

-Treat migraines rapidly and consistently without recurrence
-Restore ability to function
-Minimize use of back up and rescue medications
-Cause minimal or no adverse effects

6

Analgesic (OTC) migraine therapy

1. Acetaminophen
2. Acetaminophen + ASA + caffeine

7

NSAID (OTC) antiinflammatory drugs

1. ASA
2. Ibuprofen
3. Naproxen
4. Diclofenac

8

Triptans (examples and MOA)

1. Sumatriptan (injection*, oral, nasal)
2. Zolmitriptan (oral, nasal)

MOA: selective agonists of 5-HT

**First line for mild to severe migraine

9

Ergotamine Tartrate

-Oral with caffeine
-Rectal suppository with caffeine
-sublingual

-These are good for people who can't take the triptans

10

Ergotamine MOA

-constrict intracranial blood vessels
-Central inhibition of the trigeminaovascular pathway

11

What are the 3 key actions of Triptans

1. Normalize dilated intracranial arteries by stimulating vasoconstriction

2. Inhibit vasoactive peptide

3. Inhibit transmission through 2nd order neurons ascending to thalamus

12

What is important to remember about the sumatriptan (imitrex) nasal spray?

one spray in one nostril only

13

What should be considered as pretreatment with the ergotamines?

consider pretreatment with antiemetic

14

What do you need to keep in mind about the dihydroergotamine nasal spray?

discard open ampules after 8 hours

15

Adjunct Migraine therapies

1. Metoclopramide (Reglan) [IV]: helpful for acute relief in office or ED. Improves bowel motility to help oral drugs reach small intestine faster

2. Prochlorperazine (Compazine) [IV or IM]: helpful for acute relief in office or ED. Avoid in parkinson's disease as this affects dopamine

16

Triptan ADE

"triptan sensations"
-tightness,
-pressure
-heaviness
-pain in chest
-neck
or
-throat

17

Sumatriptan indications

1. Migraine
2. Cluster

18

Migraine preventative therapy

-Propranolol**
-Timolol
-Divalproex sodium
-Topiramate

**Trial for 2-3 months**

19

What drug is taken in the perimenstrual period to prevent menstrual migraine?

Frovatriptan

-can also take Ibuprofen (motrin) for menstrual migraine prevention

20

What drug is helpful for migraine with aura and menstrual migraine?

Magnesium

(side note: OCPs are contraindicated in migraine with aura)

21

Prophylactic migraine therapies

-Magnesium
-MIG-99
-Riboflavin
-Melatonin
-Butterbur

22

Prophylactic managmment of migraine

Headaches in predictable pattern (ex. menstrual migraine) --> NSAID or triptain

Healthy or comorbid hypertension or angina--> B-adrenergic antagonist (ex. Propranolol)

Depression or insomina + migraine --> tricyclic antidepressant

Seizure + migraine --> anticonvulsant

23

Tension-Type Headache Tx

1. Cognitive-Behavioral therapy (stress management, relaxation, training)

2. Acetaminophen

3. NSAIDs (Ibuprofen, ASA, Diclofenac, Naproxen)

24

Treatment length for tension type headache

-Butalbital - no more than 3 days

-Combination analgesics (ex. ASA, Acetaminophen, caffeine) - no more than 9 days

-NSAIDs - no more than 15 days a month

25

Cluster headache: Tx

Abortive treatment:
-100% O2
-Triptan (spray or injection, more effective than oral, except zolmitriptan)
-Ergotamines (IV)

Prophylaxis:
-Verapamil