Headache Pharmacology (NEURO) Flashcards
Key characteristics of migraines
• Headache lasting 4-72 hours • Any 5 points of listed below • Characteristics o Unilateral o Pulsating o Moderate to severe pain o Aggravated by activity • During headache o Nausea/emesis o Photophobia • Aura o Occurs during the migraine o Unilateral o Reversible visual, motor, speech/language, sensory or CNS symptoms
Tension headaches
• > 10 attacks 30 min to 7 days • Characteristics (Any 2) o Bilateral o Not pulsating o Mild or moderate intensity o Not aggravated by physical activity • No nausea or vomiting • One or neither photophobia or homophobia
Cortical Spreading Depression or Spreading of depression or Leao (SD)
Speed?
- Speed: 3-6 mm/s
- Neural depolarization that slowly moves across the cortex followed by hyperpolarization (depression) end us with decreased blood flow
- Loss of normal response to high CO2 but normal response to BP change
Trigenminovascular neuroinflammation & migraine
- Trigeminal nerve (CN V) innervated meninges and meningeal blood vessels
- Stimulation of CN V
a. CSD
b. Physical exertion
c. Diet
d. Hormonal changes
e. Head trauma
f. Sleep deprivation/excess
g. Environmental factors - CN V (i.e. CSD) releases of
a. CGRP (feedback with NO)
b. Substance P
c. Neurokinin A - Vasodilation & sterile neurogenic inflammation
- Blood flow changes
Cutaneous allodynia
• cutaneous allodynia inside and outside their pain-referred areas during migraine attacks
• Primary neuron is peripheral CN V, if you do not stop this neurons activation early you end up activating other neurons
o Secondary: Central trigeminal
o Tertiary: Forehead allodynia
o Quaternary: Thalamic
o Extracephalic allodynia
Tension headachea acute treatment
- NSAIDs BEST
- Acetaminophen
- Aspirin
- Ibuprofen
- Ketoprofen
- Naproxen
Tension headache chronic
- Amitriptyline
* NSAIDs NOT USEFUL
Cluster headaches - acute treatment
Acute • Sumatriptan • Oxygen • Intranasal lidocaine • Intranasal zolmitiptan • Ergots • Avoid NARCOTICS
Cluster headaches chronic treatent
- Verapamil
- Occipital nerve bloc
- Steroids
- Lithium
- Valproate * topiramate
Acute migraine treatment 3 key points to remember
about administration
- Non-oral routes (nausea & vomiting)
- Give adequate dose early one (prevent allodynia)
- Metoclopramide (anti-nausea)
Name 5 classes of drug s that can used to manage migraines acutely
NSAIDS Opioids Neuroleptics Barbiturates Triptans
Ergotamines
- Which receptrs are activated
- Physoiological affects
V• Receptor activation o Serotonin o Adrenergic o Dopaminergic • Suppress neurogenic inflammation • Vasoconstriction (avoid in CAD) • Used IV, IM or intranasal
Triptans
- WHich receptors
- Side effects
- Which has the longest half life
- Which is the gold standard (smallest bioavaibility)
- Drug-drug interations
• Serotonin agonist of neurons & blood vessels • Vasoconstrictions • Side effects o Chest/neck tightness o Flushing o Sedation • Contraindication o CAD o Stroke Frovatriptan • Longest half life Sumatriptan • gold standard Smallest bioavailability MAOI SSRIs Rizatriptan levels increased by propranolol
Name 4 classes of drugs that can be used for migraine prophlaxis
- B-blockers
- Antidepressants: Amitriptyline
- Antiepileptic: Valproic acid, topiramate
- Botulinum toxin: Prevents Ach, glutamate & CGRP release
Children & headeaches
Acute
Prophlaxis
What do you avoid
Acute: Acetaminophen, ibuprofen, Sumatriptan
Prophylaxis: Flunarizine (Ca channel blocker)
AVOID ASPRIN
