Migraine and Headache Flashcards by Aika Bush

Prevalence of migraine

-higher in US than rest of world
-30% people experience Aura
-affects women more than men
-Peaks in ages 25-55
-40% of people benefit from treatment

How well did you know this?

Not at all

Perfectly

Pathophysiology of migraine

-wide range of factors and mechanisms involved
-depends on genetics, anatomical, and environmental factors

How well did you know this?

Not at all

Perfectly

Diagnosis of migraine

-ICHD-3 criteria
-at least 5 attack fulfilling the criteria

How well did you know this?

Not at all

Perfectly

Cortical Spreading Depression (CSD)

responsible for aura and activation of trigeminovascular system

How well did you know this?

Not at all

Perfectly

Dysmodulation

-theory that migraines w/o aura are associated with abnormal neuronal excitability and response to sensory stimuli

How well did you know this?

Not at all

Perfectly

Describe process of CSD

-5HT and CGRP and other vasoactive neuropeptides released
-causes vasodilation, inflammation, and pain perception

How well did you know this?

Not at all

Perfectly

Phases of a migraine attack

-predrome
-aura
-headache: mild, moderate, severe
-Postdrome

How well did you know this?

Not at all

Perfectly

Criteria for Migraine without Aura

-4-72 hours
-pain (need 2 of 4): Intensity mod to severe, Unilateral, Pulsing/throbbing, aggravated with activity
-in addition to (1 of 2): N/V, Sensitivity to light/sound
-75% of people experiance neck pain

How well did you know this?

Not at all

Perfectly

Tension type headache criteria

-30 mins to 7 days
-pain(2 of 4): Bilateral, pressing/tightening, mild to moderate, not aggravated by activity
-In addition to: no nausea, photo or phonophobia

How well did you know this?

Not at all

Perfectly

Mnemonic for diagnosing Migraine Without Aura

-AUSTIN
-Activity aggravates
-Unilateral
-Sensitivity to light/sound
-Throbbing
-Intensity moderate to severe
-Nausea/vomiting

How well did you know this?

Not at all

Perfectly

Episodic Migraine

< 15 HD/month

How well did you know this?

Not at all

Perfectly

chronic migraine

> 15 HD/month

How well did you know this?

Not at all

Perfectly

Headache History

-age of onset
-time from onset to peak intensity
-pain scale
-aggravating
-associated symptoms

How well did you know this?

Not at all

Perfectly

Red flags for secondary headache

-Investigate SNOOP symptoms
-Systemic symptoms: fever, rash, stiffness
-Neurologic symptoms: confusion, weakness, vision changes
-onset: sudden, thunderclap
-Onset >40 years
-Pattern change: change in features

How well did you know this?

Not at all

Perfectly

What is a migraine?

-loss of central inhibition and ability to accommodate various stressors

How well did you know this?

Not at all

Perfectly

Migraine Triggers

-Fasting
-Medication
-Circadian Rhythms
-Environmental
-Hormones
-Stress

How well did you know this?

Not at all

Perfectly

MIDAS

-Migraine Disability Assessment

How well did you know this?

Not at all

Perfectly

Non-pharmacologic tratments

-biofeedback
-progressive relaxation
-cool compress
-rest in cool dark place
-hydration
-acupuncture/massage
-headache diary

How well did you know this?

Not at all

Perfectly

Level A complementary treatments

-butterbur extract 75 mg BID

How well did you know this?

Not at all

Perfectly

Level B complementary treatments

-feverfew
-Magnesium oxide (500mg/day)
-B2 (400mg/day)

How well did you know this?

Not at all

Perfectly

Level C complementary treatments

Study These Flashcards

-Coenzyme Q-10 300 mg/day

Specific migraine medications

Study These Flashcards

-for moderate to severe HA
-triptans
-ergotamine derivatives
-Gepants
-Lasmiditan

Opiate medications for migraine

Study These Flashcards

-Butorphanol
-tramadol
-Acetaminophen with (codeine/hydrocodone/tramadol)
-NO BUTALBITAL containing products

Dihydroergotamine(DHE)

Study These Flashcards

-high affinity for 5-HT1b/d
-interact with many others
-Many side effects: N/V, diarrhea, vasoconstriction
-Most effective at first sign of migraine
-risk of stroke and/or gangrene when taken with CYP3A4 inhibitors

DHE dosage form

-nasal spray -injection

5-HT1 agonist

treatment of migraine

5-HT2 antagonist

prevention

5-HT3 antagonist

N/V

What triptans can be repeated in 2 hours?

-Almotriptan -Eletriptan -Frovatriptan -Rizatriptan -Sumatriptan(PO, nasal spray, powder) -Zolmitriptan(PO, Nasal spray)

How often can you repeat a dose of Lasmidtan PO?

never, one dose in 24 hours -don't drive for 8 hours

How often can you repeat a dose of Naratriptan?

-4 hours -long half life

Contraindications and precautions for triptans

-heart disease -coronary vasospasm -co concurrent us of ergot derivative -pregnancy: minimize exposure -MAOI -SSRI

triptan drug interactions

-MAOI: avoid within 2 weeks -Ergots: avoid for 24 hours -SSRIs and SNRIs: Serotonin syndrome -oral contraceptive: increase triptan conc.

Cimetodine/Zolmitriptan drug interaction

-use zolmitriptan 2.5 mg

Propranalol and Rizatriptan

-increase triptan plasma conc by 70%

Eletriptan drug interactions

-CYP3A4 -avoid nefazodone, clarithromycin 0azoles. grapefruit juice

Common triptan side effects

-tingling -warmth -flushing -chest and neck pressure -dizziness -somnolence -abnormal taste with nasal formulations -injection site burning at injection site -REPORT CHEST PAIN

Ubrogepant

-repeat in 2 hours -nausea, somnolence, dry mouth

Rimegepant

-orally disentegrating tab -single dose

Zavegepant

-nasal spray -distorted tased, nausea, nasal discomfort

Medication overuse headache

-more than 15 headaches/month for more than 3 months -its important to ensure that patients do not over use their medications

Who gets preventative migraine treatment?

-more than 4 migraines/month -disruption in life -a lot of pain

Divalproex

-weight gain, hair loss, tremor, tetratogenicity -migraine prevention

Topiramate

-Migraine prevention -weight loss, psycomotor slowing, difficulty concentrating -teratogenicity

Beta Blockers

-migraine prevention -lowers BP and HR -exercise intolerance -depression -contraindicated in asthma/COPD

Tricyclic antidepressants

-migraine prevention -sedation, weight gain, anticholinergic syndrome

Botox

-chronic migraine headache small doses in head and neck every 3 months -sore neck, droopy eyelids -effect noticed in a month

CGRP antagonists

-migraine prevention -reduce frequency of migraines by 50% -constipation, site irritation -EXPENSIVE -can be combined with oral agents

Rimegapant

-ODT 75 mg every other day -migraine preventionA

Atogepant

-migraine prevention and acute treatment -10, 30, 60 mg daily

Migraine with aura and birth control

-risk factor for ischemic stroke -don't use COC

Menstrual migraine

-acute treatment: ergos or triptans -phrophalactic treatment: NSAIDs(2 days before), Frovatriptan or naritriptan 6 days before -COC extended dosing -estradiol gel 6 days before and after -magnesium day 15 to end of cycle

Migraine and Headache Flashcards

(52 cards)