L09 HA stuff

Question 1

Migraines criteria

Answer 1

1. 5 headaches
2. each lasts 4-72 hrs
3. (2/3) Unilateral, pulsating, mod-severe intensity, pain ↑s with activity
4. (1/2) nausea, photophobia, phonophobia

Question 2

4 phases of migraines

Answer 2

1. Premonitory
   - mood, alertness, apetite
2. Aura
   - neuro symp preceding HA
3. HA and assoc. symptoms
4. Resolution
   - post event exhaustion/lethargy

Question 3

abortives for migraine HA

Answer 3

triptans (sumatriptan)
ergot alkaloids

(if mod-severe that have not responded to NSAIDS)

Question 4

prophylactics for migraine HA

Answer 4

*BB
CCB
TCAD (amitriptylines)
Anti-epileptics

*note: use BB to block B2 vasodilation (vasodilatory HA)

Question 5

Tension HA

Answer 5

1. 10 HA (ten-sion for ten HA)
2. Each lasts 30 min-7 days
3. (2) pressing or tightning, mild-mod, bilateral, not aggravated by physical act.
4. NO nausea, has EITHER photophobia or phonophobia

Question 6

Abortive tx for tension HA

Answer 6

• 1. acetaminophen
• 2. NSAIDs
     
     3. aspirin

Question 7

CLuster HA

Answer 7

1. 5 HA
2. each lasts 15-180 min
3. severe, unilateral, periorbital, temporal
4. 8x daily

Question 8

abortive tx for cluster HA

Answer 8

1. O2,
2. Ergos
3. lido
4. corticosteroids
5. nerve blocks

Question 9

Trigeminal Neuralgia

Answer 9

very brief pain: intense, sharp, superficial, stabby

Question 10

Which HA is asssoc. with “worst HA of my life?”

Answer 10

subARACHNOID

- aneurysm rupture 80% (that isnt trauma)

Question 11

If Subarachnoid hem is suspected and CT scan is (-), what test do you do?

Answer 11

Lumbar puncture - most sensitive at 12 hours (poor in first few hours)

Question 12

6th nerve palsy is a sign of?

Answer 12

Increased ICP (pseudotumor cerebri) from distention of the nerves in the subarachnoid space

Question 13

Prophylactics for tension HA

Answer 13

TCADs - SSRIs (amitriptylene)

Question 14

First phase of migraine is___ .

Answer 14

cerebral vasoconstriction and ischemia

• causes the aura that precedes the HA
• 5-HT release contributes to this

Question 15

Second phase of migraine is ____

Answer 15

cerbral vasodilation and pain

• trigeminal neurovascular sys appears to have central role (Sub P)

Question 16

Triptan MOA

Answer 16

agonist at 5HT 1B/1D → vasoconstriction

(reverses vasodilating/throbbing HA)

Used to treat mod-severe Migraines

Question 17

Ergot alkaloids (dihydroergotamine) MOA

Answer 17

Same as triptans

agonist at 5HT 1B/1D → vasoconstriction

Presynaptic Inhibition

(less effective and more toxic than triptans - not 1st line)

Question 18

Chronic migraine approach (15 or more HA days a month)

Answer 18

AAA

Antihypertensives
- BB, CCB, ACE-I

Antidepressants
- amitriptyline

Anticonvulsants
- gabapentin

Botox

Question 19

Role of Serotonin 5-HT on tx and prev of HA

Answer 19

agonist of 5HT 1B/1D (Triptans + Ergots) important

Question 20

Main effects of sumatriptan

Answer 20

Agonist of 5HT1D

1. Cerebral vasoconstriction (reverse dilatory HA)
2. ↓ NT Presynaptic release (↓ vasodilation, pain, inflam)
3. Prevent activation of pain fibers in trigem nerve

(antimigraine)

Question 21

adverse drug rxn of tripans

Answer 21

coronary vasospasm

(this is also why its bad to use additive vasoconstriction w/ ergots)

Serotonin syndrome

Question 22

adverse drug rxn of ergots

Answer 22

vascular occlusion
gangrene
- mediated a-1 adrenergic vasoconstriction

Question 23

Using what with ergots is bad?

Answer 23

non-sel B1-B2 beta blockers = severe peripheral ischemia

Triptans - careful for additive vasoconstriction