Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

444-Oncology and Neurology > Headache Disorders > Flashcards

Headache Disorders Flashcards

1
Q

migraines, TTH, and trigeminal autonomic cephalalgias are classified as

A

primary headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

secondary headaches are _______

A

symptoms from organic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is classified as episodic infrequent TTH

A

<1/mth for no greater than 10 attacks/yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is classified as episodic frequent TTH

A

up to 14 attacks/ mth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is classified as chronic TTH

A

15 days or more per mth for >6mths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

onset of TTH is

A

any age, but less in those >50yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TTH may be precipitated by

A

mental stress and tension, smoking, fatigue, prolonged poor body posture (ex- excessive computer use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TTH lasts

A

30min-7hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TTH headaches have at least 2 of the following qualities (4) + both of the following

A

bilateral
pressing/ tightening (nonplusing)
mild/ mod intensity
not aggravated by routine physical activity

both: no N/V, either photophobia or phonophibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

migraine RFs

A

family hx (strong predictor), females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

migraines
1. with aura are more prevalent than without
2. onset is always <50yrs and are more common in F
3. may be triggered by a TTH
4. are only diagnosed after having at least 2 attacks if aura is present
5. 2,4

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the diagnostic criteria of migraines without aura

A

At least 5 attacks fulfilling criteria B-D
HA lasting 4-72hrs (untreated or successfully tx)
HA has at least 2 of the following characteristics: unilateral location, pulsating quality, mod or severe pain intensity, aggravation by or causing avoidance of routine physical activity
During HA at least one of the following: N and/or V, photophobia and phonophobia
Not attributable to another disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how many attacks must happen for migraines without aura to be dx

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how long do migraines without aura last

A

4-72hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

a migraine with aura has at least 2 of the following characteristics (4)

A

unilateral location
pulsating quality
mod or severe pain intensity
aggravation by or causing avoidance of routine physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how many attacks does a pt need to have to dx migraine with aura

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

each aura sx lasts

A

5-60min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the classifications of cluster headaches? describe them

A

episodic CH: has remission inbetween
chronic CH: with no significant remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

onset of cluster HA is usually

A

any age, more commonly 28-30yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how many cluster HAs must happen before dx

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how long do cluster HAs last

A

15-180min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

a headache is pulsating, unilateral, and lasted 2 days. what kind of HA is this
1. TTH
2. migraine
3. cluster

A

2 (4-72hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

a headache is unilateral right above the eye, causes agitation, and lasts 20 minutes. what kind of HA is this
1. TTH
2. migraine
3. cluster

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are some red flags of headaches (list 3)

A

onset >50yrs or <5yrs, severe + abrupt onset of HA “thunderclap”, ↑ freq or severity, sig changes in pattern (atypical), other sx like stiff neck, reduced consciousness, fever, sick appearance, new onset HA during pregnancy (refer), cluster headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

generally, HA should be prophylaxed if

A

they’re frequent- using analgesia >15m/mth or 2d/wk
severe and disabling
short lived- esp with cluster HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the principles of HA prophylaxis

A

use long acting for adherence, in cluster HA- start chronic prophylaxis while on transitional prophylaxis, if pt is attack free for 6-12mths- consider tapering the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when can you consider tapering dose of HA prophylaxis

A

if pt is attack free for 6-12mths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

1st line TTH tx

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

2nd line TTH tx

A

caffeine + NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what should be avoided in trying to treat TTHs

A

acetaminophen with or without codeine (increased risk of dependency + MOH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

do TTH generally require prophylaxis?

A

no- usually mild- mod + short duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

when might prophylaxis be considered fro TTH

A

if attacks are severe enough to limit ADL
frequent (>2-3/wk)
analgesics are CI, ineffective, or overused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is commonly used for TTH prophylaxis

A

amitriptyline (TCAs), may also use venlafaxine and mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

HA response to amitriptyline is usually seen in

A

2-3wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

2 forms of care for migraines

A

stratified vs stepped acre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the stratified care model for migarines

A

Migraine attack
Mild disability = simple analgesic
Mod- severe disability = triptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

describe the stepped care across vs within migraines attacks model

A

across: Migraine attack → simple analgesics (≥ 3 consecutive attacks with no/ insuff response) → migraine attack → triptans

within: Migraine attack → simple analgesic (within same attack with no/ insuff response) → triptan

38
Q

if triptans are not effective/ CI/ not available for migraine tx, what should be used?

A

ditan or gepant

39
Q

compare ASA and NSAIDs to triptans in efficacy

A

less effective

40
Q

compare ergotamine and caffeine to triptans in efficacy

A

less effective

41
Q

NSAIDs, acetaminophen, ASA use should be limited to ____ to avoid MOH

A

<15d/mth

42
Q

butalbital combination analgesics use should be limited to ___ to avoid MOA and risk of dependency

A

<10d/mth

43
Q

what is 1st and 2nd line migraine tx

A

1st line: NSAIDs, APAP, ASA
2nd line: triptans

44
Q

when are triptans indicated in migraines

A

mod-severe migraines
when analgesics + NSAIDs are ineffective and used too frequently

45
Q

triptan AEs

A

fatigue, dizzinses, drowsiness, paresthesias, N, abdominal pain, chest discomfort

46
Q

absolute CIs to triptns

A

IHD or any cardiac like sx, stroke or TIA, peripheral vascular disease like ischemic bowel disease, basilar or hemiplegic migraine, use with ergot derivatives and MAOi

47
Q

5 relative CIs to triptns

A

uncontrolled HPTN, pregnancy or BF, smoking
Caution when coadmin with SSRis and SNRIs d/t ↑ risk of serotonin sx

48
Q

triptans should not be used within 24hrs of antoher

A

triptan or ergot

49
Q

triptans should not be used within ____ of another triptan or ergot

A

24hrs

50
Q

triptans should be used ____ to avoid MOH

A

<10d/mth

51
Q

how soon can you repeat a sumatriptan dose

A

2hrs

52
Q

PO sumatriptan dose is usualy

A

25-100mg

53
Q

rank the onset speed of sumatriptan formulations

A

SC >INH >PO

54
Q

sumatriptan ___ is v effective for severe migraines and acute cluster HAs

A

SC

55
Q

which triptan has the lowest SEs

A

naratriptan

56
Q

what is the slowest osnet triptan

A

naratriptan

57
Q

which triptan is good for relief of nausea

A

rizatriptan

58
Q

________ increases bioavailability of rizatriptan

A

propranolol

59
Q

what is 3rd line migraine tx

A

triptans + NSAIDs

60
Q

4th line migraine tx

A

ergot derivatives

61
Q

what is a dihydroergotamine

A

an ergot derivative for migraines

62
Q

ergot derivates AEs

A

AEs: N/V (v common = give antiemetics prior to IV dose), chest discomfort, fatigue, dizziness, drowsiness, cramps, paresthesias, vasoconstriction

63
Q

what can be given with DHE to relieve N/V

A

Metoclopramide 10mg IV or prochlorperazine 5mg IV can be given pre IV

64
Q

how many days can ergot derivatives be used for

A

<10d

65
Q

what tx should be avoided for migraine tx

A

opioids
butalbital

66
Q

codeine or tramadol combo analgesics should be used when

A

NSAIDs or triptans are CI/ poorly tolerated
as rescue meds

67
Q

what are GEPANTs

A

calcitonin gene related peptide receptor antagonists

68
Q

ubrogepant and rimegepant are

A

GEPANTs

69
Q

GEPANTs are effective within

A

2hrs in mod-severe migraine

70
Q

lasmiditan is a

A

ditan

71
Q

how long for lasmiditan to kick in

A

2hrs in mod-sevre migraine

72
Q

what is a major advantage of lasmiditan

A

it’s not a vasoconstructor

73
Q

AEs of lasmiditan

A

temporary driving impairment (no driving for 8hrs post dose)

74
Q

when should migraines be prophylaxed

A

attacks severe enough to limit ADL, frequent, ≥3x attacks/ mth that are resistant to therapy, migraine meds are CI or failed

75
Q

6 classes for migraine prophylaxis

A

ACEi/ARBs
antiseizure meds
BB
CCB
calcitonin gene related peptide antibody
TCAs

76
Q

when are calcitonin gene related peptide antibodies used for migraine prophylaxis

A

only when other agents are ineffective

77
Q

TCAs are preferred for migraine prophylaxis when

A

pt has depression/ insomnia

78
Q

migraines in the ER are treated with

A

Sumatriptan SC, metoclopramide IV, prochlorperazine IV, opioids, DHE, meperidine, ketorolac IM/IV (only NSAID parenteral), corticosteroids (IV dex 6-10mg, associated with reduced HA recurrence for up to 3d)

79
Q

why is abortive tx difficult in cluster HAs

A

challenged by short nature. By the time PO kicks in, it’s already gone

80
Q

3 first line abortive tx in cluster HAs

A

O2, sumatriptan SC, zolmitriptan IN

81
Q

when is response expected in using O2 to treat cluster Hs

A

30min

82
Q

1 spray of zolmitriptan nasal spray is effective within

A

30min

83
Q

sumatriptan SC is effective within

A

20min

84
Q

4 drugs for cluster prophylaxis

A

verapamil
lithium
topiramate
melatonin

85
Q

which migraine med classes should not be used >10d/mth

A

opioids, triptans, ergots, butalbital combos

86
Q

treatment for menstrual migraine

A

triptan BID starting 2 days prior to onset of menses, continuing for 5-7 days
add NSAIDs BID (starting 2 days before period, continue for 5-6d)

87
Q

how to treat TTH in pregnnacy

A

some actually report improvement due to pregnancy (hormones
tx with APAP prefered
NSAIDs fine bewteen 20-30wks

88
Q

how to tx acute migraines in preg + how to prophylax

A

acute :analyesics, possibly sumatriptan
prophylaxis: low dose propranolol, Mg, possibly amitriptyline

89
Q

how to treat acute cluster HA in preg women

A

tx with oxygen, may use SC/IN sumatriptan

90
Q

how to prophylax cluster HA in preg women

A

verapamil or prednisone, gabapentin as alt

91
Q

what headaches drugs to avoid in alctation

A

ergots, barbiturates, opioids

444-Oncology and Neurology (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions