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PHAR 557 > Headache > Flashcards

Headache Flashcards

(103 cards)

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1
Q

Headache disorder classifications:

A
  1. primary h/a disorder

2. secondary h/a disorder

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2
Q

Name 3 types of primary headache disorder

A

migraine, tension-type h/a’s, and cluster h/a’s

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3
Q

Which gender suffers from migraines more?

A

Females

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4
Q

Why are migraines a huge economic burden?

A

Bc they often affect ppl during the most productive yrs of life

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5
Q

What is the most accepted etiology of migraines?

A

complex dysfns in neuronal and sensory processing

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6
Q

Where does migraine pain START?

A

trigeminovascular system activity

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7
Q

Pathophysiology of migraines:

A

Trigeminal sensory nerves activate > vasoactive neuropeptides released > vasodilation of dural blood vessels > inflammation > pain impulses travel along trigeminovascular fibers > pain impulses arrive at trigeminal nucleus and higher cortical pain centres > continued pain input from afferent sensory fibers > hyperalgesic state > previously innocuous stimuli now cause h/a perpetuation

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8
Q

What’re the 4 phases assoc w/ the clinical presentation of migraine h/a’s?

A

premonitory sx’s, aura, migraine attack, postdrome

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9
Q

Distinguishing feature of premonitory phase of migraine h/a’s.

A

There’s no pain involved

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10
Q

Premonitory phase of migraine h/a synonyms:

A

prodrome, warning

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11
Q

Common sx’s of premonitory phase of migraine h/a’s?

A
  1. neurological (allodynia [pain from normally non-painful stimuli], phono/photophobia)
  2. psychological (anxiety, dep, euphoria)
  3. autonomic (polyuria, diarrhea)
  4. constitutional (neck stiffness, yawning, thirst)
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12
Q

How long before migraine attack do premonitory sx’s usually appear?

A

hours to days before h/a

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13
Q

how long before a migraine h/a do auras usually appear?

A

5-20mins

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14
Q

Sx’s of aura?

A

Often visual (flashes, colours appear brighter, blind spot, sig blindness)

sensory and motor sx’s are also possible

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15
Q

How long do migraine attacks usually last

A

4-72h

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16
Q

T or F: All migraine sufferers experience auras before their migraine attacks

A

F

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17
Q

What is the most important element in establishing a clinical dx of migraine?

A

a h/a hx

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18
Q

Shorthand way of dx’ing migraine:

A

POUND

  1. pulsatile
  2. one to three day duration
  3. unilateral
  4. N/V
  5. Disabling intensity of h/a
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19
Q

Red flag sx’s assoc w/ h/a (refer immediately):

A
  1. suspected stroke/TIA
  2. head trauma
  3. h/a gets worse
  4. memory loss
  5. suspected glaucoma (eye pain = major sx)
  6. sudden onset (seconds to 5 mins)
  7. worst h/a ever
  8. fever, neck stiffness, impaired level of consciousness accompany h/a
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20
Q

What’s the main goal when tx’ing migraines?

A

Getting the pt to return to normal activities within 2h’s of tx

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21
Q

Primary non-pharm approach to migraine tx:

A

Identify and avoid triggers

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22
Q

What approach to tx should be used when tx’ing acute migraines?

A

stratified approach

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23
Q

What’s the stratified approach to tx’ing migraines?

A

severity of migraine informs tx choice (i.e. drug is chosen based on how bad the migraine is/how disabled the pt is by it)

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24
Q

What are the advantages of using a stratified approach to acute migraine tx?

A

Works faster + lower numbers of initial tx failures

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25
T or F: Opioids are first line for acute migraines.
F > weak evidence
26
What can be added if pt is experiencing N during an acute episode of migraine?
metoclopramide
27
Which drug classes have been shown to be the best for tx'ing acute migraines?
triptans, NSAIDs (inc. ASA), and acetaminophen
28
MOA of triptans
5HT-1B/1D agonists vasoconstriction of meningeal blood vessels, inhibit vasoactive neuropeptide release by trigeminal nerves, and inhibit pain signal transmission
29
CI of triptans
Cerebrovascular/cardiac dz, HTN (since triptans constrict cerebral blood vessels), hemiplegic migraine
30
If s.o is experiencing N/V during an acute migraine, what route(s) of triptan should be used for triptan admin?
Nasal or SC
31
T or F: Serotonin syndrome is possible with triptans.
T (it's a 5HT agonist)
32
When should triptans be taken?
At earliest onset of migraine pain
33
T or F: Taking a triptan before onset of pain (i.e. during premonitory or aura phases) is more effective than taking it during the acute migraine phase.
F
34
Which triptans are postulated to be the most effective in relieving acute migraine pain?
Eletriptan and rizatriptan
35
Why would rizatriptan be preferred over eletriptan in SK?
Rizatriptan (eletriptan is non-forumulary in SK)
36
Sumatriptan + naproxen combo tx has been shown to be better for acute migraine tx than either monotx.
T
37
What should triptans not be used with? Why?
dihydroergotamine (DHE) > additive vasoconstriction
38
Ergots - MOA
5-HT-1D agonists > vasoconstriction of intracranial blood vessels and inhibition of proinflam neuropeptide release
39
T or F: Ergots and triptans have similar MOAs
T
40
T or F: Ergots are first line for acute migraines
F (NSAIDs/triptans/acetaminophen are)
41
Regular intake of ergotamine or DHE can cause what?
Ergotism and gangrenous sx's
42
When would dihydroergotamine be used?
moderate-sev migraine attacks or refractory h/a's
43
Sumatriptan nasal spray vs. dihydroergotamine nasal spray: which is better for acute migraine tx?
sumatriptan nasal spray
44
Opioids: Place in tx for acute migraine?
None - they do not change the pathophys of acute migraines
45
MOA of antiemetics used for migraine-induced N/V?
D2 antagonists (reduces N), increases absorption of other meds, decreases gastric stasis
46
Which oral antiemetic is used for migraine-induced N/V?
metoclopramide
47
What can be used for acute migraines if triptans are CI'ed or not tolerated?
Metoclopramide + analgesic (NSAID)
48
T or F: Tx's for migraines can end up causing migraines if used too much.
T (medication-overuse headache)
49
What are the diagnostic criteria for med-overuse h/a?
1. h/a for ≥ 15 d/month in a pt w/ pre-existing h/a disorder | 2. regular overuse for > 3 months of ≥ 1 drug that is used for h/a tx
50
T or F: In med-overuse h/a's, analgesic overuse can lead to migraine h/a's, whereas triptan overuse can lead to tension-type headaches
F Other way around (analgesic > tension-type; triptan > migraines)
51
Which med classes are consistently linked to med-overuse h/a's?
Opioids and barbiturates (hence another reason to avoid them to tx h/a's)
52
What med class is MOH-protective? What is the caveat to its protective property?
NSAIDs > protective if used for < 10d/month
53
When should a migraine sufferer be admitted into hospital?
1. status migrainosus - severely painful and lasting > 72h 2. severe N/V that leads to dehydration 3. detox from overuse of combo of analgesics, ergots, or opioids
54
What should be used for status migrainosus?
1L of NS bolus (PRN); if not effective... sumatriptan (if triptans/DHE not tried yet) and/or ketorolac; if not effective... metoclopramide; if not effective... DHE + metoclopramide
55
When should DHE be taken if triptan taken previously?
12h after triptan dose
56
How long will migraine prevention tx take?
Several weeks for full effect
57
When is migraine prevention indicated?
When there's sig disability or reduced QoL despite appropriate acute tx
58
When should preventative tx of migraines be tapered/stopped?
After 6-12 mths of benefit
59
When are preventative tx's of migraines considered to be successful/beneficial?
when freq of attacks are reduced by ≥ 50% OR when number of days w/ headache/month is reduced by ≥ 50%
60
First line for migraine prophylaxis:
Beta blockers (propranolol, metoprolol, timolol) or TCAs (amitriptyline, nortriptyline)
61
1st line for severe migraine prophylaxis:
Anticonvulsants
62
Which anticonvulsants are recommended for severe migraine prophylaxis?
Valproate, topiramate
63
Which anticonvulsant is NOT recommended for severe migraine prophylaxis?
Gabapentin
64
CCB effectiveness in migraine prevention?
Limited data, so usually avoid
65
Botulinum toxin place in tx for migraine prophylaxis?
For chronic or episodic migraines
66
When must migraines occur in a woman's cycle for them to be considered "menstrual migraines"?
2d before to 3d after menstrual bleeding
67
Prevention tx for menstrual migraines:
1. NSAIDs | 2. Triptans
68
What has chasteberry been used for?
Menstrual migraine
69
T or F: NHPs are usually used before Rx products wrt migraine tx
F
70
Pediatric tx options for migraines?
Similar to adults: 1. NSAIDs 2. Triptans 3. Sumatriptan + naptroxen combo
71
Preventative tx for migraine in pediatrics is better supported compared to adults.
F
72
1st line migraine tx in preggos?
Non-pharm stuff
73
If meds req'd, what's 1st line in preggos for migraine tx?
Acetaminophen
74
If meds req'd, what's 2nd line in preggos for migraine tx?
ibuprofen, naproxen
75
What should we know about NSAID use in preggos for migraines?
Avoid in 3rd trimester
76
If meds req'd, what should we use if migraine is assoc w/ severe N in preggos?
Metoclopramide or prochlorperazine
77
If meds req'd, what's used for prophylaxis in preggos?
propranolol, magnesium
78
1st line for migraine tx in lactating mothers?
acetaminophen
79
2nd line for migraine tx in lactating mothers?
ibuprofen (preferred NSAID)
80
What two meds are avoided when tx'ing migraines in preggos?
Ergot derivatives and triptans
81
What's first line in preggos for migraine prophylaxis?
propranolol, Mg
82
T or F: Valproic acid/divalproex is CI in lactating mothers for migraine prophylaxis.
F (they're compatible)
83
Sx's of tension-type h/a's
pain is bilateral, nonpulsatile, mild photophobia/phonophobia may occur, pericranial tenderness
84
1st line for tension h/a tx?
ibuprofen, naproxen, acetaminophen
85
What ISN'T helpful for tension h/a's?
codeine products, muscle relaxants
86
Mainstay for tension h/a prophylaxis?
lifestyle measures
87
T or F: Caffeine combination products w/ simple analgesics are more effective for tension h/a's than simple analgesic monotx.
T
88
What is a post-traumatic h/a?
a h/a that develops within 7 days of a. head injury, b. regaining consciousness post-injury c. d/c'ing med that prevented sensation of h/a following head injury
89
How should post-traumatic h/a's be tx'ed?
Based on standard acute tx protocols (e.g. if it presents like a migraine, tx with migraine meds, etc.)
90
This type of h/a is aggravated by physical activity
Migraines
91
This type of h/a lasts 30 mins to 7d
Tension
92
Pressing and tightening pain is characteristic of which type of h/a?
Tension
93
Describe the pain experienced during a migraine
Throbbing, pulsating
94
N/V may accompany this type of h/a
Migraine
95
T or F: N/V may be present in both migraines and tension h/a's.
F (not tension h/a's)
96
How are simple analgesics (acetaminiophen, NSAIDs) used in migraines?
first line for mild-mod migraine attacks
97
How are simple analgesics used in tension h/a's?
first line +/- caffeine
98
How are triptans used in migraines?
1st line for mod-severe attacks
99
How are triptans used in tension h/a's?
usually no role
100
How is DHE used in migraines?
mod-severe pain if triptans fail/not an option
101
How is DHE used in tension h/a's?
no role
102
How're antiemetics used in migraines?
adjunctive role w/ simple analgesics or migraine specific tx for aborting migraine
103
How're antiemetics used in tension h/a's?
limited role

PHAR 557 (36 decks)

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