Hedaches

Question 1

For Mild to Moderate pain Migraine Headaches

Answer 1

NSAIDs and ASA

Question 2

First line. For moderate to severe migraine headaches

Answer 2

Triptans. MOA- vasoconstriction- treats pain and nausea

Question 3

Caffeine containing products used for migraines should not be used more than….

Answer 3

three days per month

Question 4

Triptans are CI for….

Answer 4

Heart Disease 
Hx of stroke
Angina
Uncontrolled HTN
Pregnancy
with an SSRI
ergots

Question 5

Ergots for migraine

Answer 5

constrict intracranial blood vessels
inhibits neurogenic inflammation
activity at dopamenic receptors

Question 6

Ergots CI:

Answer 6

Preg Cat X
Not to be used within 24 hours of a triptan 
heart disease 
renal failure
liver failure
uncontrolled HTN

Question 7

Cluster Headache treatment:

Answer 7

Can use the same as for migraines
if triptans or ergots can’t be used then sandastatin can be
100% O2 at 5-10L/min for 15 minutes

Question 8

Prophylaxis for migraine

Answer 8

If pt has frequent HA, pain is severe, and medication is being used 2+ times per week, prophylaxis is indicated.
BB
TCA
NSAID
CCB
anticonvulsants
serotonin antagonist

Question 9

Define migraine HA

Answer 9

common, recurrent, primary headaches of moderate to severe intensity that interfere with normal functioning and are associated with G.I., neurological, and autonomic symptoms.
They are more common in women than men.
Average age of onset is 15 to 35 years old with a peak between the ages of 35 to 45.
Family history is commonly seen.
They are unilateral in nature.
You will frequently see a premonitory symptoms or aura. Premonitory symptoms can include photophobia, hypersomnia, irritability, drowsiness, or appetite changes. These can occur hours to days before the onset of a migraine headache.


Question 10

Define Cluster HA

Answer 10

Cluster headaches are less common than migraine and tension headaches.
They affect less than 1% of the population and are more common in males than females.
They result from a hypothalamus dysfunction causing disruption of circadian rhythms.
You usually see them at specific times during the sleep wake cycle at night.
The pain is very severe and centers around one eye.


Question 11

Define tension HA

Answer 11

Tension headache is the most common type of primary headache.
Muscle contraction is the most significant factor that causes pain.
They are characterized by mild to moderate pain, non-pulsatile in nature, and bilateral.
The pain usually radiates from the forehead to the occiput. They are not associated with premonitory symptoms or auras.
They usually develop later in the day and are most commonly seen in adult females.


Question 12

Beta Blocker for Migraine prophylaxis

Answer 12

propranolol and timolol
can’t use the triptan Riza with propranolol, must use other triptan
CI with pt who have airway disease and conduction issues

Question 13

CCB for migraine prophylaxis

Answer 13

verapamil is most used. used for intolerance to BB, can take 6-8 weeks to see benefit, helps with pain and aura
2/3rd line

Question 14

TCA for migraine prophylaxis

Answer 14

Can be used first line
amitriptyline nortriptyline imitripline
not to be used with a triptan- SS

Question 15

Antiepileptics for migraine prophylaxis

Answer 15

Valproic Acid, topriamate
Preferred agent of BB is not tolerated
Just as beneficial as propranolol

Question 16

Tension Headache prophylaxis

Answer 16

TCA

Question 17

Cluster HA prophylaxis

Answer 17

CCB- verapamil

Question 18

Tension Headache prophylaxis preferred treatment is

Answer 18

TCA first line

Effexor, Remeron second line

Question 19

Cluster HA prophylaxis preferred treatment is

Answer 19

CCB- verapamil

Question 20

lithium can be used for

Answer 20

Cluster HA prophylaxis. Should be dosed at bedtime. The dose must be adjusted renally and monitored closely with serum levels. It is contraindicated in patients who are also on a thiazide diuretic, an ACEI, or an ARB.

Question 21

Migraines in pediatrics- pearls and treatment

Answer 21

more frequent in boys until puberty
more frequent in girls post puberty 
Tylenol or Motrin, avoid ASA
can give antiemetic- pref phenergan 
triptans >12yoa

Question 22

HA in pregnancy- pearls and treatment

Answer 22

Tension HA are seen more than migraine
HA due to estrogen flux
Tylenol is safest
Avoid NSAID in 3rd trimester, premature arteriole ductus closure
Opiods are second line, use sparingly
Prednisone, methylprednisone for iretractable HA preferred

Question 23

HA in pregnancy- CI

Answer 23

Triptans and ergots should be avoided
beta blockers and calcium channel blockers can lead to maternal hypotension.
Antiepileptic drugs have not been studied in this population.


Question 24

primary HA

Answer 24

underlying attributable cause and include migraine, tension, and cluster.

Question 25

Secondary HA

Answer 25

Secondary headaches can be attributed to a specific etiology and include headaches caused from trauma, infection, vascular or intracranial disorders, substance use, or medication overuse.


Question 26

Migraine HA triggers Behavioral

Answer 26

fatigue or sleep excess/deficit female cycle- hormones stress excessive physical activity

Question 27

Tension HA second line

Answer 27

NSAID- Motrin, aleve etc...

Question 28

Diagnosis of Migraine with Aura

Answer 28

At least two of the attacks include: Reversible Aura symptoms- visual, speech, motor, eye, brainstem ``` At least 2 of the 4: 1 aura for 5 min or two back to back each aura last 5-60min at least 1 aura is unilateral aura is followed by a headache ```

Question 29

Diagnosis Frequent Tension Type

Answer 29

at least 10 episodes occurring 1-14d per month for > 3 most that: last 30m-7d No NV Either photophobia or photophobia- not both not attributed to another disease state tightening in quality bilateral pain does not worsen with routine physical activity **Infrequent THA are the same as above but occur less than one day a month on average **

Question 30

Diagnosis of Cluster HA

Answer 30

Severe pain, centers around one eye. hypothalamic disruption that disrupts circadian rhythms Occurs at specific times during the sleep wake cycle- More common in men

Question 31

Migraine triggers - Food

Answer 31

``` ETOH Caffeine intake/withdrawl chocolate citrus bananas figs/rasins dair fermented foods monosodium glutamate nitrites saccharin/aspartame sulfites- wine, shrimp etc tyramine- cheese wine, beer, organ meats yeasts ```

Question 32

Migraine triggers - Food

Answer 32

``` ETOH Caffeine intake/withdrawal chocolate citrus bananas figs/rasins dair fermented foods monosodium glutamate nitrites saccharin/aspartame sulfites- wine, shrimp etc tyramine- cheese wine, beer, organ meats yeasts ```

Question 33

Migraine triggers - medication

Answer 33

``` estrogen/contraceptives indomethacin (NSAID used in gout, arthritis etc) cimetidine (antacid) nitrates nifedipine - CCB Reserpine Theophylline withdrawal of analgesic, decongestants, Benzos, ergots ```

Question 34

Tension HA third line

Answer 34

Fioricet or Fiorinal - not to be used for more than 3 days - can causes MOH

Question 35

CCB's used

Answer 35

verapamil 120-320mg amlodipine 2.5-10mg Main AE- constipation

Question 36

Define MOH and explain how it is treated

Answer 36

Overuse of OTC headache medications can cause rebound headaches. Cyclic. Treating more than 2 HA or migraines can lead to MOH

Question 37

BB's used

Answer 37

``` timolol 20-30mg propranolol 80-240 atenolol 50-200mg metoprolol 50-200 nadolol 20-160 ```

Question 38

Anti epileptics used

Answer 38

``` Gaba 1200-2400mg Lamotrigine - 50-200mg Topiramate 50-200 Valproic Acid 500-1500 Depakote 500-1500 ```

Question 39

Dx of Migraine without aura

Answer 39

``` At least 5 attacks that: last 4-72 hr Has 2 of the 4: unilateral pulsating moderate to severe pain aggravated by routine physical activity, or avoidance of ```

Question 40

Tension HA Dx

Answer 40

frequent

Question 41

When initiating drug therapy for Tension HA, ....

Answer 41

Hold OTC for 1-2wk