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Flashcards in Headache Disorders Deck (44):
1

First line therapy for migraines involves either a Step-therapy or a Stratified therapy. Step therapy involves

1. Treat with NSAIDs or combo (with an opiate or narcotic)
2. switch to a migraine specific agent if no response to NSAIDs

2

Stratified therapy involves

Going straight to migraine specific agents in severe migraine

3

Non-Specific migraine treatment (4 things)

-NSAIDs
-Analgesics
-Antiemetics
-Corticosteroids

4

Migraine-specific treatment (2 things)

-Ergot derivatives
-5-HT1B/ID agonists

5

This class of drugs are first line for mild to moderate migraines

NSAIDS

6

This class of drugs is reserved for severe migraine if HA is unresponsive to other treatments

Opiods

7

This drug is a synthetic narcotic antagonist-agonist used for severe migraine. It is a nasal spray

Butorphanol

8

This drug causes a depressant effect on the CNS

Butalbital

9

This class of drugs is used for non-specific migraine treatment in combination w/ analgesics or codeine

Barbiturate combinations (hypnotics)

10

This class of drugs act as 5-HT1 agonist, activity of alpha, beta-adrenergic receptors and DA receptors

Ergot alkaloids

11

Name two types of ergot alkaloids

Ergotamine tartrate (rectal, PO, SL)
Dihydroergotamine (inj, nasal spray)

12

Acute side effects include N/V (surely), diarrhea, abdominal pain, weakness, leg cramps, tremor, dizziness, syncope

Ergotamine

13

Acute side effects include chest pain, intermittent claudication, and syndrome ergotism

Ergotamine

14

name the syndrome: peripheral ischemia, cold/numb extremities, diminished peripheral pulses

syndrome of ergotism

15

Chronic side effects include: cerebral/peripheral ischemic disorders, HTN, tachy/brady, medication overuse HA, renal D/O, and withdrawal signs

Ergotamine

16

Contraindications include use of triptans within 24 hours

Ergotamine

17

This drug is a CYP 3A4 substrate that has interactions with strong 3A4 inhibitors, triptans, and Fluoxetine, fluvoxamine

Ergotamine

18

These drugs are selective 5-HT 1B/1D agonists

triptans

19

These drugs are first line for moderate to severe migraine

triptans

20

Triptan available as SQ injection, oral tabs, and nasal spray

Sumitriptan

21

Triptan available in oral tabs and oral disintegrating tabs

Rizatriptan

22

Triptan available as oral tabs, oral disintegrating tabs, and nasal spray

Zolmitriptan

23

Side effects include dizziness, fatigue, flushing, nausea, chest tightness/pain/pressure, injection reaction, and taste perversion from spray

Triptans

24

Contraindications include: Ergot alkaloid in last 24 hours, MAOI in last 2 weeks, uncontrolled HTN, ischemic heart disease, basilar/hemiplegic migraine

Triptans

25

Interaction of triptan with these 2 classes of drugs increases risk of serotonin syndrome

MAOI, SSRI

26

Results in hypothermia, muscle rigidity, myoclonus, rapid change in mental status and vitals

serotonin syndrome

27

1st line agents for prophylactic migraine treatment

beta blockers
tricyclic antidepressants

28

ADRs include fatigue, vivid dreams, depression, impotence, bradycardia, hypotension

beta blockers

29

Antagonist of 5-HT2 receptors inhibiting the reuptake of serotonin and causing an increased concentration of serotonin at the synaptic cleft

TCAs

30

ADRs include sedation, constipation, blurred vision, and hypotension

TCAs

31

Name 4 other drugs/classes that can be used as prophylactic migraine treatment

Anticonvulsants
Calcium channel blockers
Methysergide
Botulinum toxin type A

32

These drugs increase the availability of GABA- inhibitory neurotransmitter

anticonvulsants

33

Dont use these prophylactic migraine drugs if the patient has liver disease

anticonvulsants

34

ADRs include tremor, weight gain, nausea, hair loss

anticonvulsants

35

These are vasodilators that cause decrease in smooth muscle tone and vascular resistance

calcium channel blockers

36

This drug is a peripheral 5-HT inhibitor but a central 5-HT agonist

Methysergide

37

can cause fatal pulmonary fibrosis

Methysergide

38

inhibits Ach release at the presynaptic cholinergic junction

Botulinum toxin type A

39

Natural products for migraine therapy include

caffeine (acute therapy)
butterbur (prevention)
coenzyme q10
feverfew

40

How do you treat an intractable migraine?

DHE
Sumitriptan
Prochlorperazine/chlorpromazine
Narcotics
Corticosteroids

41

How do you treat tension type headache acutely?

Analgesics (APAP, ASA, Ibu, naproxen)
Sedatives (butalbital)

42

How do you treat tension type headache prophylactically?

TCAs
Muscle relaxants
Botulinum toxin

43

How do you treat cluster HA acutely?

Imitrex
O2 inhalation
Ergotamine
DHE-45
Lidocaine

44

How do you treat cluster HA prophylactically?

Verapamil
Prednisone
Ergotamine
Methysergide
Litium