Headaches Flashcards
(44 cards)
Tension HA characteristics and?
Pressing/tightening (non-pulstatile), mild-mod intensity, bilateral, no aggravation by physical activity. Both: Nausea/Vomiting, +/- photophobia, phonophobia
Divalproex sodium contraindications
AEs, monitoring? What form is best
- Severe hepatic insufficiency, preg, pancreatitis
- GI upset, somnolence, weight gain, tremor, alopecia, hepatotoxic, thrombocytopenia, pancreatitis
- CBT, LFTs
- ER is better
Antiemetics are usually used as?
Adjunctive treatment with acute attacks
Rebound HAs Whats mess commonly cause?
Occur when analgesic medications are used excessively to treat HA - HAs increase in pain and intensity/ pain and occur daily - Discontinuation often leads to gradual reduction in frequency. - Analgesics, mixed analgesics containing but albeit also, caffeine, or isometheptene, erogotamine, opiates, triptans, Opiods and butalbital - Acute therapy no more than twice/week to protect against rebound
Other analgesics
Pts that are intolerant or contraindicated or for rescue therapy - Short acting barbiturates combined with ASA or APAP - Isometheptene compounds (Midrin) - Opiate analgesics (oral combos, parenteral, and butorphenol NS) - Tramadol - These commonly cause rebound headaches
Secondary Causes of infection
Infection, head injury, hemorrhage, Brain tumor, Drug induced (vasodilator, estrogen)
More common for women or men?
Women
What triptan should generally be avoided because of drug interactions?
- Eletriptan
Summary of acute treatment guidelines
Nate SAID hid Pappy Trips ERlot when he takes Narcotics and Pukes
Typically you usually start with an NSAID, the APAP + ASA + Caffeine Then DHE nasal spray, Triptan Initial treatment with triptans in patient with mod-severe migraines
Preventative treatment
Titration, might need to try more than one.
What triptans should be used with N/V?
- Sumatriptan
- Zolmitriptan
Lower level evidence migraine prevention
SSRis, Gaba, Carb
Antiepileptics for migraine prevention?
- Divalproex sodium
- Topiramate
- Gabapentin and Carbamazepine are less effective
Stratified and Step care approach
Strat: Rate HA prior to treatment - Use treatment based on severity, Better outcomes, Examples 1/5 main NSAID, 4/5 triptan Step care- always start with mild therapy and step up if HA persists Example: 1 use NSAID, 2nd analgesic combo, 3rd use triptan
What ergot alkaloid derivative is the only first line for treatment?
DHE NS after an NSAID is tried
Migraine prophylaxis
- Beta blockers, antiepileptics, antidepressants, others
Acute Migraine Treatment DIs
Ergot and Derivatives?
- Triptans within 24 hours
- MAOIs (CI within 2 weeks)
- Potent 3A4 inhibitor (CI)
- SSRIs
Physicals and Labs for headache?
Physical exam, CT, MRI, LP, CBC, TSH
POUND
Pulsating, One day, Uni, N/V, Disabling
Antiemetics Commonly used agents
- Combat N/V and vomiting that accompany the HA - IV metoclopramide has been known to treat pain - metoclopramide, prochlorperazine, promethazine - 15 minutes prior to oral acute treatment med - May be given parenterally or via suppository if needed - AEs CNS and EPS
Ergot Alkaloid derivatives are generally?
Not recommended
Acute treatment goals
- Dont want recurrence, restore function
Triptan DIS
MAOIs and ergot Dont use within 24 hours SSRIs and risk of serotonin syndrome -
Non pharm treatment for HA
- Relaxation training, Biofeedback, CBT, Avoid migraine triggers (bright lights, loud noise, allergens, weather changes, chocolate/cheese/ caffeine, Alcohol, MSG, Aspartame), Hormonal changes, sleep deprivation
