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Flashcards in Headache Meds Deck (39)
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1
Q

3 primary headaches (see the chart on slide 5)

A

Migraine headache, tension headache, cluster headache (there’s an “other” category too)

2
Q

Secondary headaches are attributed to:

A

Head/neck trauma, cranial/cervical vascular disorders, infection, psych disorders

3
Q

Acetaminophen

A

Acts centrally

Possible 1st choice in acute migraine for those with mild/moderate attacks or CIs to NSAIDs/ASA

4
Q

Butalbital in Fioricet and Fiorinal

A

Limited efficacy, abuse potential, withdrawal, med overuse

Prob won’t use this

5
Q

Midrin C-IV (ASA, isometheptene, dichloralphenzone)

A

Alternative for mild/moderate migraine (Iso = vasoconstriction, dichlor = analgesic/sedative)

6
Q

Excedrin Migraine OTC

A

First-line treatment choice for mild/moderate migraines or severe if worked in the past (has caffeine so watch for caffeine withdrawal headaches if taking daily0

7
Q

NSAIDs

A

Migraines: prevents trigeminovascular inflammation

DOC for mild/moderate attacks or severe if worked before (use ASA, ibuprofen, or naproxen)

Use <15 days per month to prevent drug overdose headache

Watch for GI SEs

8
Q

Ergotamine

A

Migraines, administer w/caffeine, lots of bad AEs, potent precipitator of med overuse headaches

CI in PVD, CAD, HTN

Pregnancy risk X, stimulates uterus

Do not use w/i 24hrs of a triptan (less effective than triptans)

Start early, pretreat w/anti-emetic for N/V, lots of AEs

Rectal better than oral

9
Q

Dihydroergotamine

A

NOT ACCEPTABLE AS MONOTHERAPY

Nasal spray for migraines, but less effective than subQ sumatriptan (IM/subQ is similarly effective)

IV = TREATMENT OF STATUS MIGRAINOSUS (RASKIN PROTOCOL)

Less vasoconstriction & N/V than ergotamine, risk of ergotism, CI in CV conditions, potent precipitator of med overuse headache

Pregnancy risk X

10
Q

List of Triptans

A
Almotriptan
Eletriptan
Frovatriptan
Naratriptan
Rizatriptan
Sumatriptan
Zolmitriptan
11
Q

1st line therapy for patients with MODERATE TO SEVERE MIGRAINES, and used for rescue therapy when nonspecific meds are ineffective

A

Triptans

12
Q

AEs of Triptans

A

Chest symptoms, paresthesia, fatigue, dizziness, flushing, pain at injection site

13
Q

Highest likelihood of consistent success was found w/ which 3 Triptans?

A

Rizatriptan, eletriptan, almotriptan

14
Q

Most likely of one all triptans to produce short-term and sustained benefit

A

Eletriptan

15
Q

Two triptans that are slower in onset and have lower efficacy?

A

Naratriptan and frovatriptan

16
Q

2 Triptans with the most number of dosing formulations available?

A

Sumatriptan and zolmitriptan

17
Q

How many days per month should triptan use be limited to?

A

Less than or equal to 9 days per month

18
Q

CIs for use of triptans?

A

Patients w/ a history of IHD

19
Q

Patients w/CAD need to have their first triptan dose where and how?

A

In the clinic w/vitals and maybe an ECG

Same in patients at high risk for it (i.e. HTN, hypercholesterolemia, obese, DM, smokers0

20
Q

DIs include?

A

Don’t use w/i 24hrs of ergotamines

SEROTONIN SYNDROME (they notice b/c their hands start shaking)

21
Q

What is the clinical triad of abnormalities experienced in serotonin syndrome?

A

Cognitive effects, neuromuscular dysfunction, autonomic dysfunction

22
Q

This triptan contains a sulfa group…

A

Almotriptan

23
Q

Antiemetic of choice in migraines?

A

Metoclopramide

24
Q

What is the best way to prevent medication overuse headaches?

A

Acutely, discontinue the offending agent, but prevention is best - LIMIT USE OF MIGRAINE THERAPIES TO 2 DAYS/WEEK

25
Q

Class of migraine meds absolutely contraindicated in pregnancy?

A

Ergots

26
Q

What is the most common type of primary headache?

A

Tension headache

27
Q

Pain thought to originate from myocardial factors and peripheral sensitization of nociceptors describes which type of HA?

A

Tension HA

28
Q

Less than 10 HA episodes occurring on less than 1 day per month on average is?

A

Episodic tension-type HA

29
Q

HA occurring greater than or equal to 15 days per month on average for greater than 3 months?

A

Chronic tension-type HA

30
Q

What are the DOCs for tension HAs?

A

Analgesics (ASA/NSAIDs)

Limit use to no more than 9 days per month. Muscle relaxants can also be used

31
Q

What is the DOC for prophylactic treatment of tension HAs?

A

Amitriptyline (TCA) - AEs = anticholinergic SEs, weight gain, oHTN, arrhythmia

32
Q

In which type of HA are hypothalamic dysfunction and/or altered circadian rhythms suspected and/or genetic roles suspected?

A

Cluster HAs

33
Q

The most severe of the primary HAs are?

A

Cluster HAs

34
Q

HAs that tend to occur nightly, over a short period of time, followed by long periods of complete remission and occur predominantly in males in their 30s?

A

Cluster HAs

35
Q

These HA attacks last 2 weeks to 3 months, often in spring and fall, occur suddenly with excruciating unilateral orbital/supraorbital/temporal pain where PT may sit and rock, or pace while clutching their head.

A

Cluster HAs

36
Q

First line treatment of cluster HAs?

A

Oxygen, NRB, 7-10L/min

37
Q

First line pharm treatment for acute cluster HA?

A

Sumatriptan is the best, but Zolmitriptan may be better tolerated in some PTs

38
Q

What is the DOC in maintenance prophylaxis for cluster HAs?

A

Verapamil - reduce frequency and severity of cluster attacks

(2nd line is lithium)

39
Q

Transitional prophylaxis meds of choice?

A

Prednisone

Dihydroergotamine has been used, but lacks evidence