Headaches Flashcards by Robert Stuver

Treatment of headaches should begin with?

Non-pharmacological methods

How well did you know this?

Not at all

Perfectly

Migraine treatment is classified as?

Specific/Nonspecific acute/abortive/symptomatic & preventive/prophylactic

How well did you know this?

Not at all

Perfectly

Analgesics for migraine treatment are…

Nonspecific, Acute

How well did you know this?

Not at all

Perfectly

Analgesics used for migraines?

aspirin, acetaminophen, naproxen, indomethacin, piroxicam, diclofenac, ibuprofen

How well did you know this?

Not at all

Perfectly

Analgesic combination useful for moderate migraine?

Acetaminophen, Aspirin, Caffeine (Excedrin)

How well did you know this?

Not at all

Perfectly

Barbiturates for migraine treatment are…

Nonspecific, Acute

How well did you know this?

Not at all

Perfectly

Have barbiturates been shown effective in RCTs?

How well did you know this?

Not at all

Perfectly

Barbiturates frequent side effects?

Drowsiness, dizziness, risk of overuse & withdrawal

How well did you know this?

Not at all

Perfectly

Opioids for migraine treatment are…

Nonspecific, Acute

How well did you know this?

Not at all

Perfectly

Opioids used for migraines?

Codein, meperidine, oxycodone, hydromorphone, morphine, methadone, butorphanol

How well did you know this?

Not at all

Perfectly

Risks of opioid use?

High risk of overuse and development of chronic daily headaches – Should not be used more than 2 days/week

How well did you know this?

Not at all

Perfectly

When are opioids for migraines most useful?

In pregnant patients (many other meds will be contraindicated)

How well did you know this?

Not at all

Perfectly

Steroids for migraine treatment are…

Nonspecific, Acute

How well did you know this?

Not at all

Perfectly

Steroids are most useful for?

Prolonged headache state (“status migrainosus”)

How well did you know this?

Not at all

Perfectly

Ergotamines for migraine treatment are…

Specific, Acute

How well did you know this?

Not at all

Perfectly

Ergotamine mxn?

Alpha-adrenergic & Serotonergic agonist

How well did you know this?

Not at all

Perfectly

Ergotamine in combo with? Given as?

Caffeine; Oral tablet or suppository

How well did you know this?

Not at all

Perfectly

Dihydroergotamine mxn?

Weak vasoconstrictor, 5HT1BD agonist: acts to reduce cell activity in the trigeminovascular system

How well did you know this?

Not at all

Perfectly

DHE given as?

Nasal spray, IM, IV

How well did you know this?

Not at all

Perfectly

DHE IV for?

status migrainosus

How well did you know this?

Not at all

Perfectly

Common side effects of ergotamine and DHE?

Nausea (ergotamines more so than DHE), vomiting, chest pain, abdominal pain, dizziness

How well did you know this?

Not at all

Perfectly

Ergotamine and DHE contraindicated in?

Pregnant women, uncontrolled HTN, sepsis, renal or hepatic failure, peripheral/coronary/cerebral vascular disease

How well did you know this?

Not at all

Perfectly

Ergotamine and DHE use should not exceed…

2 dosage days/week

How well did you know this?

Not at all

Perfectly

Premier migraine abortive meds?

Triptans

How well did you know this?

Not at all

Perfectly

Triptans for migraine treatment are...

Speficic, acute

Name the seven available triptans.

Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan, Zolmitriptan

Most widely used triptan?

Sumatriptan

Sumatriptan is most effective given as?

SC (versus oral or nasal)

Triptan mxn?

5HT1BD agonists: Penetrate the CNS and cause vasocnstriction of extracerebral intracranial vessels and inactivation of the trigeminal system.

Is there evidence of use of triptans during the aura phase?

No, but shown to be effective in reducing associated symptoms.

Triptan side effects?

Flushing, tingling, chest discomfort (noncardiac)

Triptans contraindicated in?

Vascular disease, uncontrolled HTN, complicated migraine syndromes

When is preventive therapy for migraine recommended?

More than 3 severe HAs/month, more than 2 mild-moderate HAs/week, inability to use effective symptomatic therapy, overuse of acute medications, patient preference and in special migraine syndromes

Avoid preventive meds for migraine when?

Pregnancy

Major medication groups used for preventive therapy for migraines?

Antidepressants, antihypertensives, antiepileptics, vitamins, minerals, many "off label"

Antidepressants for migraine treatment are...

Preventive

First antidepressants used for migraine treatment? Then?

TCAs, SSRIs

TCAs used for migraine treatment?

Amitryiptyline, nortriptyline, protriptyline

Only TCA with consisten support for migraine prevention?

Amitryptyline

SSRIs used for migraine treatment?

Fluoxetine, paroxetine, setraline (useful when coexistent depression)

TCA side effects?

Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension

SSRI side effects?

weight gain, sexual dysfunction

Antihypertensives for migraine treatment are...

Preventive

Commonly used antihypertensive classes for preventive migraine therapy?

Betablockers & Calcium channel blockers

Beta-blockers used for preventive migraine tx? Which ones are FDA approved for this?

Timolol and propanolol (approved) + nadolol and atenolol (longer half life and tolerability, hence their use)

Antihypertensives side effects?

drwosiness, depression, hypotension, decreased libido, memory disturbance

Antihypertensives contraindicated in?

Asthma, diabetes, CHF, Raynaud's

Most commonly used calcium channel blocker for preventive migraine tx? When is this most useful?

Verapamil -- Considered most useful in those with prolonged/disabling aura & for complicated migrain syndromes

Side effects of verapamil?

Constipation, dizziness

Antiepileptics as migraine treatment are...

Preventive

What is divalproex sodium?

Extended release form of valproic acid formulation (AED)

AED approved for migraine prevention?

Divalproex sodium

Divalproex sodium side effects?

Sedation, hair loss, weight gain, tremor, changes in cognition, hepatotoxicity, blood dyscrasia, pancreatitis

Most frequently used AED for migraine prevention?

Topiramate (approved)

Topiramate side effects?

Changes in cognition, paresthesias, weight loss, kidney stones, acute angle-closure glaucoma, decreased sodium bicarbonate

Botox for migraine treatment is...

Preventive for chronic migraines (>15 days/month for >3 months)

Botox side effects?

injection site pain, HA post injection, neck weakness, ptosis

Most common acute drug therapy for TTH?

Simple analgesics

Analgesics in combo w/ what for acute TTH tx?

Caffeine, codeine, anxiolytics

Most effective NSAIDs for acute TTH tx?

naproxen, ketorolac, indomethacin

Will muscle relaxants help episodic TTH?

When should preventiv drug tx be considered for TTH?

If frequence >2/week, if duration is >4/hour, and if severity may lead to significant disability or med overuse. This is the mainstay therapy for chronic TTH.

Preferred preventive therapy for chronic TTH?

Antidepressants (TCAs, then SSRIs)

Which TCA is most effective in preventive CTTH tx?

Amitriptyline

Will muscle relaxants help prevent CTTH?

Yes. Example: Tizanidine

Can Botox be used in preventive CTTH tx?

Maybe

Therapies for cluster headache acute treatment? Which is considered first line?

Triptans (first line), oxygen, DHE, anasthetics (lidocaine)

Prophylactic therapy for cluster headaches can be?

Short-term, long-term

Short-term prophylactic therapy for cluster headaches?

Oral corticosteroids, ergotamine

Long-term prophylactic therapy for cluster headaches?

Verapamil, Topiramate, Divalproex, Sodium, Lithium

Lithium side effects?

Weakness, nausea, thirst, tremor, lethargy, blurred vision, slurred speech, vomiting, anorexia, diarrhea, confusion, nystagums, EPS, seizures

Avoid these with lithium? Why?

Indomethacin, Sodium-depleting diuretics -- Increase lithium levels

Most common cause of chronic daily headaches?

Med overuse

Leading culprits of "rebound phenomenon"?

Caffeine & Barbiturates