Headache treatment Flashcards Preview

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Flashcards in Headache treatment Deck (25):
1

Migraine characteristics

- Unilateral, gradual onset (4-72 hours), N/V, photophobia and phonophobia, Aura

2

Tension headache characteristics

- Bilateral, pressure comes and goes

3

Cluster headache

- Unilateral eye, quick onset, excruciating, lacrimation and rhinorrhea, sweating, horner's syndrome,

4

Mild HA and Menstrual HA usually treated with

NSAIDS

5

Moderate to severe HA

give a short acting triptan (sumatriptan)

6

Cluster HA

triptan or ergot

Or a "burst and taper" steroid like prednisone

7

Analgesic overuse

too much migraine treatment, headaches get worse, start them on prophylactic treatment

8

How do NSAIDs work

Inhibition of cyclooxygenase enzymes which decreases the synthesis of inflammatoyr mediators like prostaglandins

See sheet for NSAIDS most commonly used for migraine

9

Triptan adverse effects

worst with SC SUmatriptan

- CNS effects- chest pain, coronary/peripheral vasospasm, contraindicated in heart disease, HTN, ischemic bowel dz.

10

What drugs are contraindicated in use within 24 hours of triptan use

ergots, MAOI, propanolol, cyp3A4 drugs

11

Treatment of headache in pregnancy is compicated. What are the big points

- NO ERGOTS EVER
- First trimester, your only option is acetaminophen
- Add opioids in later trimesters if you need to
- NO NSAIDS in the Third Trimester

12

Oral contraceptives + smoking + migraines=

BIG RISK FOR STROKE

Remember that oral contraceptives are pro-clot

13

What must you watch for with pts who take acetaminophen for headaches

G6PD deficiency

14

How do triptans work

Selective for serotonin receptors B/D. They decrease the release of CGRP and substance P and thus lead to vasoconstriction

15

Sumatriptan

This is the drug that can be given in a subcu injection for cluster headaches (10 min onset), also has an oral form (30 min) and a nasal spray (15min)

16

Sumatriptan AEs....really just AEs for the triptans but they are worse for sumatriptan

CNS effects,
CHEST PAIN, CORONARY/PERIPHERY VASOSPASM
contraindicated in heart dz, HTN, ischemic bowel dz

17

The two triptans we need to know

suma and ele

ELe has a 30 min onset and a longer half life (4.5hrs) than suma (2.5)

18

In small doses, ergots cause what

vasoconstriction of small arteries

19

In large doses ergots cause

paralyze the nerve endings of sympathetic fibers

20

Adverse effects of ERGOTS

- NEVER use in pregnancy, cat x

21

Metoclopramide

Central D2 blocker....remember it can be used pre-surgery to speed up the GI tract.

May give guys tits because of high prolactin

22

Prochlorperazine

D2 blocker. Cholinergic and alpha adrenergic blocker. Causes the opposite of sludgebbb

23

Chlorpromazine

D2 blocker. same as prochlorperazine

24

Promethazine

cholinergic blockade

Anti-H1 and weak D2.

25

ONLY APPROVED DRUG FOR PED MIGRAINE PROPHYLAXIN

Propanolol