Headache management

Question 1

What is a Medication-overuse Headache/Rebound Headache

How does this happen?

Answer 1

The frequent or excessive use of acute migraine medications

headache returns as the medication wears off, leading to the consumption of more drug for relief.

Question 2

How can you prevent rebound headaches?

Answer 2

Limit the use of acute migraine therapies to fewer than 10 days per month

Question 3

What are symptoms associated with Migraine headaches

Answer 3

Frequently unilateral

untreated can last from 4 to 72 hours

nausea, vomiting
sensitivity to light, sound, and/or movement

Question 4

What is an important part of the pathophysiology that cause migraines?

Answer 4

Activation of trigeminal sensory nerves triggers the release of vasoactive neuropeptides

Question 5

What drugs fall under Analgesic class

Answer 5

Acetaminophen (Tylenol)

Acetaminophen 250 mg/aspirin 250 mg/caffeine 65 mg (Excedrin Migraine)

Question 6

What drugs fall under NSAIDS

Answer 6

Aspirin
Ibuprofen (Motrin)
Naproxen sodium (Aleve, Anaprox)
Diclofenac (Cataflam, Voltaren)

Question 7

What drugs fall under Serotonin Agonists (Triptans)

Answer 7

Sumatriptan

Zolmitriptan

Question 8

What do Non-selective 5-HT1 receptor agonists do?

Answer 8

Constrict intracranial blood vessels and inhibit the development of neurogenic inflammation in the trigeminovascular system

Question 9

MOA of Triptans?

Answer 9

Selective agonists of the 5-HT1B and 5-HT1D receptors

Result of three key actions:

• normalization of dilated intracranial arteries through enhanced vasoconstriction
• inhibition of vasoactive peptide release from perivascular trigeminal neurons
• inhibition of transmission through second-order neurons ascending to the thalamus

Question 10

What is the maximum dosage of oral Sumatriptan?

Answer 10

200 mg max dosage

Question 11

What should you avoid with oral and nasal Zolmitriptan?

Answer 11

Do not divide the two forms

Question 12

When taking Ergotamine what should you take with it?

Answer 12

consider pretreatment with an antiemetic

Question 13

What are Metoclopramide useful for Prochlorperazine

Answer 13

Useful for adjunct therapy relief in the office or emergency department setting

Also is an anti-emetic

Question 14

What is an Adverse event when taking Triptan

Answer 14

“Triptan sensations”

Chest tightness,
pressure,
heaviness, or
pain in the chest, neck, or throat

Question 15

What can Sumatriptan be used for to treat?

Answer 15

Migraine AND cluster headache

Question 16

ADE of Sumatriptan?

Answer 16

Paresthesias, dizziness, chest pain

• possible coronary vasospasm

Question 17

How do you treat Serotonin syndrome caused by Triptan drugs?

Answer 17

Sedation (benzodiazepines)
Paralysis
Intubation and ventilation

Question 18

How do you treat Neuroleptic malignant syndrome

Answer 18

Diphenhydramine (parenteral),

cooling if temperature is very high

Question 19

How do you treat Malignant hyperthermia

Answer 19

Dantrolene, cooling

Question 20

What medications can be used as preventative therapy for migraines

Answer 20

Propranolol
Timolol
Divalproex sodium
Topiramate

Question 21

What migraine med can be used intermittently, such as for menstrual migraine prevention

Answer 21

Ibuprofen

Question 22

What migraine med can be taken in the perimenstrual period to prevent menstrual migraine

Answer 22

Frovatriptan

Question 23

MC type of headache?

Answer 23

Tension type headache- pain is like a band squeezing the head

Question 24

1st line treatment for Tension Headaches?

What is another alternative

Answer 24

Simple analgesics - Acetaminophen

NSAIDS

Question 25

When treating Tension headaches, butalbital-containing meds should be taken no more than how many times per month

Answer 25

3 days

Question 26

When treating Tension headaches, combination analgesics meds should be taken no more than how many times per month

Answer 26

9 days

Question 27

When treating Tension headaches, NSAIDS should be taken no more than how many times per month

Answer 27

15 days

Question 28

What meds can be used for preventative therapy for Tension type headaches

Answer 28

TCAs (tricyclic antidepressants) | SSRIs (Selective Serotonin Reuptake Inhibitors) --> only effective in patients who also have depression

Question 29

What is not recommended for preventative therapy for Tension HA?

Answer 29

Botulinium toxin

Question 30

What are cluster headaches and how are they described?

Answer 30

Headache around the eye Excruciating, unilateral head pain that occur in series lasting for weeks or months

Question 31

What is a hallmark finding of Cluster HA?

Answer 31

circadian rhythm of painful attacks.

Question 32

What is the standard of treatment for Cluster HA?

Answer 32

Abortive Therapy Inhalation of 100% oxygen by nonbreather facial mask Triptans sprays or injections Ergotamine Derivatives --> Clinically IV dihydroergotamine , or ergotamine tartrate

Question 33

What is 1st line PROPHYLACTIC treatment of Cluster HA

Answer 33

Verapamil