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OMS - 2 Neuro Final > Headache & Facial Pain > Flashcards

Headache & Facial Pain Flashcards

(41 cards)

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1
Q

Calcitonin gene-related peptide (CGRP) antagonist: pathways

A
  1. These receptors occur at all Sites involved in migraine pathogenesis as well as vasodilation
  2. Locations: DRG, CN V & X gnaglia, dorsal horn, trigeminal nucleus caudallis, nucleus of the solitary tract, brainstem, amygdala, hypothalamus, hypothalamic nuclei, dorsal insular cortex
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2
Q

GCRP’s actions (6)

(calcitonin gene-related peptides)

A
  1. Vasodilation
  2. Mast cell degranulation
  3. Dural inflammation
  4. Peripheral sensitization
  5. Pain transmission
  6. Central sensitization
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3
Q

______ is released into the jugular venous system during migraine which in turn evokes the migraine.

A

CGRP’s (calcitonin gene-related peptides)

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4
Q

Antibodies to CGRP or its receptor prevents migraine by _______ (2)

A
  1. Removing excess CGRPs released from the trigeminal nerve endings
  2. Receptor antibodies blocks the receptor from signaling transmission
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5
Q

Anti-CGRP monoclonal Antibodies have ______% responder rate.

A

75

(rapid onset, good tolerance & safety, no neutralizing antibodies detected)

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6
Q

Go-to medication for migraine?

A

Anti-CGRP monoclonal antibodies

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7
Q

Short term side effects of anti-CGRP monoclonal antibodies (4)

A
  1. URI
  2. nausea
  3. hyper-sensitivity rxn
  4. constipation
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8
Q

Potential long-term side effects from anti-CGRP monoclonal antibodies (4)

A
  1. pituitary dysfxn
  2. cardiovascular (ischemia, HTN)
  3. GI (ulcer, IBS)
  4. Skin (infalammation, wound healing)
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9
Q

Botox MOA

A
  1. Produces sensory input to CNS
  2. Reduces input to muscle spindle
  • Decreases Nocioceptor Pathways
  • C and A delta fibers
  • Substance P
  • CGRP
  • Glutamate release
  • Mechano- and Chemo-receptors
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10
Q

Botox has been approved for chronic migraine by the FDA if _____ (2).

A
  1. Greater than 15 headaches per month (have them keep a headache calendar)
  2. Failed two classes of prophylactic medications
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11
Q

Botox includes _____ injections each treatment, over _____weeks.

A
  • 30 to 40
  • 12

(Cost 300 to $600 for treatment)

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12
Q

Which drugs have level A (evidence-base medicine grade - more than 1 class 1 trial) (5)?

A
  1. Anti-CGRP mAb (MC used)
  2. Antiepileptic
  3. Beta blockers
  4. Botulinum toxin A
  5. Triptans
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13
Q

Define status migrainosus (2)

A
  • Migraine that lasts over 72 hours
  • Refractory to Conventional treatment
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14
Q

Status migrainosus treatment (4)

A
  1. Steroid burst (dexamethasone or prednisone)
  2. Headache cocktail (3 different cocktails)
  3. IV valproate
  4. DHE-DiHydroErgotamine (last resort: must be admitted, Neurologist handles this)

(DO NOT give opioids)

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15
Q

Headache cocktails for status migrainosis (3)

A
  1. Ketorolac, Diphenhydramine, Prochlorperazine
  2. Metoclopramide, Benadryl, Ibuprofen
  3. DHE Nasal spray, prochlorperazine (DHE- must admit & call neurologist)
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16
Q

Emergency room treatment for status migrainosus (5)

A
  1. IV normal saline (if they’ve been vomiting/diahrrea)
  2. Diphenhydramine
  3. Metoclopramide
  4. Magnesium Sulfate
  5. Ketoralac

(all via IV. If no response: Valproate, Levetiracetam, Methylprednisolone, Dihydroergotamine)

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17
Q

Behavioral treatments for headache (5)

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A
  1. Relaxation training
  2. Hypnotherapy
  3. EMG or thermal Biofeedback
  4. Cognitive behavioral therapy
  5. RELAXaHEAD app
18
Q

Physical Treatments for headache (6)

Study These Flashcards
A
  1. Acupuncture
  2. Heat
  3. TENS
  4. Occlusal adjustment (TMJ)
  5. OMM
  6. Yoga
19
Q

Over-the-counter supplements for headaches (9)

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A
  1. Magnesium
  2. Riboflavin
  3. Melatonin
  4. CoQ10
  5. Butterbur
  6. Feverfew
  7. Petadolex
  8. Topical Menthol
  9. Neti Pot (if congested and pain over sinuses)
20
Q

Lifestyle modifications for headaches (6)

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A
  1. Diet
  2. Environment
  3. Exercise
  4. Sleep
  5. Stress Management
  6. Tobacco cessation
21
Q

FDA approved devices to treat headaches (3)

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A
  1. TENS (prevention & acute)
  2. GammaCore - Vagus N. Stim
  3. Transcranial Magnetic Stimulation (SpringTMS)
22
Q

TENS unit for migraine? How does it work?

Study These Flashcards
A
  • Cefaly device
  • Targets trigeminal nucleus caudal: slows modulation of cortical areas
23
Q

What is the only FDA approved treatment for cluster?

Study These Flashcards
A

VNS device: gammaCore

(mostly used in headache clinics)

24
Q

How long does a cluster headache last?

(suicide headache)

Study These Flashcards
A

15-180 minutes

25
Cluster headache sx (4) | (suicide headache)
1. lacrimation 2. forehead, facial sweating 3. mitosis and/or ptosis 4. restlessness or agitation
26
MC trigger for cluster headache/suicide headache
alcohol
27
Best treatment for cluster/suicide headache?
oxygen by face mask
28
cluster headache pain location (3)
1. unilateral orbital 2. supraorbital 3. temporal
29
Tx for cluster headache (3) | (other than O2)
1. Sumatriptan 2. Zolmitriptan 3. VNS 4. Sub-occipital steroid injections
30
Medication over-use headache duration
15 days/month
31
Medication over-use headache criteria
1. overuse for \>3 months of one or more drugs 2. headache occurring on 15 days/month (not better accounted for by another dx)
32
medication overuse headache typically occurs in which patient population?
migraine & cluster/suicide headache patients
33
Medication/overuse headache tx (4)
1. steroids 2. ketorolac 3. tizanidine 4. DHE (40% relapse)
34
Pregnant patients: how many have headaches?
30%
35
2 MC types of headache in pregnant patients?
1. Migraine w/o aura 64% 2. Tension 26%
36
Causes of migraine in pregnant patients (6)
1. hormones 2. sleep difficulty 3. low blood glucose 4. dehydration 5. nasal congetion 6. caffeine/sugar withdrawal
37
Non-pharmacologic tx for migraine in pregnant patients (6)
1. 2. cold compress 3. warm bath 4. massage, acupuncture, OMM 5. cefaly 6. hyperbaric O2
38
Migraine in pregnancy rx (4)
1. acetaminophen 2. metoclopramide 3. prednisone (category B) 4. Triptans (category C)
39
Opioid analgesics that are Category B; safe for pregnancy (3)
1. codeine 2. oxycodein 3. meperidone
40
Prophylactic treatment for disabling migraine attacks in pregnant patients (4)
1. Beta blockers 2. magnesium 3. riboflavin 4. fluoxetine
41
Rx that must be avoided in pregnancy (6)
1. barbituates 2. benzos 3. ergotamine or DHE 4. butterbur 5. feverfew 6. Co-Q10

OMS - 2 Neuro Final (36 decks)

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