Flashcards in Headaches Deck (73):
What % of office and ER visits involving headaches have serious pathology?
How do we classify headaches?
Primary (no other cause)
Secondary (some other cause)
What are some red flags of secondary headaches?
Change/progression in headache pattern
Neurological sx > 1 hour
How do you describe the pain of a tension headache?
Mild-moderate dull ache
What are tension headaches usually lacking?
Signs of serious underlying conditions
Generalized pain. fever, stiff neck, recent trauma
What are the OTC analgesics that pts often self treat tension headaches with?
Other agents (17%)
What NSAIDS and acetaminophen agents are more effective than placebos 2 hours after tx? What is their dosage?
Ibuprofen 400 mg po
Acetaminophen 1000 mg po
Ketoprofen 25 mg po
What should you limit analgesia intake per week to? Why?
Prevent medication overuse headaches
What can you augment tension headache (TH) tx with? Give some examples.
If augmented TH tx isnt working, what should you try?
Acetaminophen/ asprin w/ caffeine and butalbital
How often can you use the acetaminophen/caffeine/butalbital combination?
< 2xs weekly
What might the use of the combo TH therapy precipitate?
Chronic daily headahce
What are some things to worry about with the TH combo therapy? What do we do to deal with this?
What are two drugs that are used as prophylaxis for TH?
How long might SSRIs take to be effective for TH?
What are some examples of SSRIs used for TH?
What are the most painful of primary headaches?
What are some associated sx with cluster headaches (CH)?
What is a key feature of CHs?
Recurrent bouts of near daily attacks
How long may CHs last?
When do CH attacks usually begin?
W/ REM phase sleep
What to pts susceptible to CHs fear?
Going to sleep
List some precipitants of a CH:
Hypoxia (sleep apnea)
How are CHs dx?
Is CH pain UL or BL?
Where is the CH pain usually localized?
CH pain is accompanied by >1 of:
Ipsilateral conjunctival injection or lacrimation
Ipsilateral nasal congestion or rhinorrhea
Ipsilateral eyelid edema, forehead & facial sweating
Ipsilateral miosis or ptosis, or
A sense of restlesness or agitation
What is the dual strategy for CH?
Acute attacks must be aborted or subdued
Prophylaxis used to suppress remaining CH
What is the tx of choice for CH? What is the dosage?
7 L/min x 15 min
What is the medication commonly given for CH? What is the dose?
6 mg SQ
20 mg NS
What is an under prescribed combo therapy for CH?
O2 and sumatriptan
Give some other examples of CH tx:
What is a tx for CH that is not effetive for CH prophylaxis?
List the prophylactic drugs for CH:
How do we classify migraines?
By their clinical features
What is one major feature of migraines?
What can aura present with? How is that classified?
Positive (scintillations, photopsia)
Negative (visual field defects)
Describe migraine pain:
How do you minimize migraine pain?
Dark, quiet location
What are other sx that accompany migraines called?
What are some common triggers for migraines? Give some examples.
Food (alcohol, caffeine, chocolate, MSG, tyramine, nitrate)
Behavioral/physiologic (changes in sleep, skipped meals)
Environmental (flickering lights)
How quickly do we need to treat migraines?
What are the goals of migraine tx?
Reduce frequency/severity of attacks
Avoid escalation of medications
What should mild-moderate or unresponsive severe migraine attacks use for tx?
Combination analgesics containing caffeine
What should mod-severe or mild mod unresponsive to NSAIDs migraine attacks use?
Migraine specific meds
Combo tx (APC = aspirin, APAP, caffeine)
What two things are not part of migraine tx?
Which is the superior care approach for migraines?
Stratified care (based on severity of disability)
What are two abortive txs for migraines?
What is ergotamine?
Nonselective 5-HT1 agonist
What is an advantage of dihydroergotamine?
Less overuse headache (replace ergotamine)
What are some drawbacks of the abortive meds?
Both are oxytocic
Contraindicated in pregnancy
Peripheral vasoconstriction (short term use)
What are triptans?
Specific 5HT1 receptor agonists
What are triptans usually reserved for?
Mod-severe migraines unresponsive to other meds
When are triptans contraindicated?
Ischemic vascular conditions
How quickly does subQ sumatriptan peak?
How quickly does oral rizatriptan peak?
What triptan has the longest half life? What might happen with this?
Decrease chance of recurrence HA
What are the principles of triptan therapy?
Try for 2-3 headache episodes before changing
If one is ineffective try another
Match drug characteristics to patient's needs
When do you consider prophylaxis for migraines?
> 2 attacks/month w/ disability > 3 days/month
Contraindications to/failure of abortive therapy
Presence of uncommon migraine conditions (hemiplegic migraine, prolonged aura)
What is an uncommon tx for migraines?
What is the MOA of botox?
Neuromuscular blocking agent
How many different sites do you inject with botox?
31 total sites
What are CGRP antagonists for migraines?
Potent vasodilators of cerebral vessels
What two things do CGRP antagonists do?
Block CGRP receptors
Inhibit CGRP directly
What is CGRP receptor antagonist?
What is the MOA of CGRP receptor antagonist?
Bind CGRP receptor blocking activation
How much do CGRP receptor antagonists reduce migraines?
To 1-2 episodes/month
How do you administer CGRP receptor antagonists?
SC injection once monthly
When are CGRP receptor antagonists indicated?
Pts who fail other drugs
Prophylaxis of migraine
What is the MOA of CGRP antagonists?
Prevents receptor activation by binding directly to CGRP
How much do CGRP antagonists reduce migraine frequency?
1-2 episodes per month
How do you administer CGRP antagonists?
SubQ injection once monthly