Test Flashcards
(30 cards)
Vascular theory
Intracranial vasoconstriction (aura) with rebound vasodilation results in headache
Neurovascular theory
Complex series of neural and vascular events
Neuronal hyperexcitability- lower threshold for development of migraine with trigger exposure
Cortical spreading depression- excitation followed by suppression results in blood vessel constriction followed by dilation resulting in aura
Trigeminovascular system
Nerves release vasoactive neuropeptides (CGRP, sub P, Neurokinin A)
Neuropeptides -vasodilation, extravasation of plasma and plasma proteins, mechanical stretching (edema), pain
Activity is regulated by serotonin
Goals of treatment
Raise threshold
Identify and avoid triggers
Abort attacks
Raising threshold
Stop frequent analgesics, opiates, barbiturates, and triptans
Begin daily prophylactic medications
Emergent referral- SNOOP
S: systemic S/Sx: fever, wt loss, HIV, malignancy, meningismus
N: neurologic: hemiparesis, hemisensory loss, diplopia
O: onset: worse headache of life, thunderclap
O: old age: new onset after age 50
P: progression of existing headache disorder- change in location or frequency
MIDAS test
I 0-5 little or no disability
II 6-10 mild disability
III 11-20 moderate
IV 21+ severe
Aborting the attack
Analgesics NSAIDS Ergot alkaloids Serotonin agonists (triptans) Opiate analgesics Antiemetics
Ergot alkaloids
Can cause rebound headache, n/v, chest tightness, ischemia
CI: vasoconstriction (MI, PVD, uncontrolled HTN, hemiplegic migraine, sepsis) triptan in pat 24, maoi in past 2 wks, 3a4 inhibitor, pregnancy
Triptan onset
Frovatriptan
Naratriptan
Zolmitriptan
120-180
60-180
45 oral/15 nasal
Triptan side effects/CI
Paresthesias, flushing, warm sensation, chest pressure/tightness, local side effects
Ischemic heart disease, uncontrolled htn, hemiplegic migraines, within 24 hr ergot or 2 wk maoi
Watch for combo that cause inc risk serotonin syndrome
Issues with opiate analgesics
Rebound headache
Dependence
How to guard against medication-overuse headache
Limit acute therapy to 2-3 days per week
Beta blockers for prevention of headaches
Propranolol
Metoprolol
Timolol
Naldolol
Atenolol
Nebivolol
Pindolol
Bisoprolol- inadequate/conflicting data
Acebutolol not effective
Raises migraine threshold
Not effective for HE
Lamotrigine Clomipramine Acebutolol Clonazepam Nabumetone Oxcarbazepine Telmisartan Montelukast
Lithium
Trough 0.6-1.2
Monitor thyroid and renal
Avoid NSAIDs and diuretics
Stages of sleep
1 - light sleep, easily awakened, sudden muscle contractions
2 - (50%) - no eye movement, slow brain waves
3 - brain waves slower, metabolic activity slows
4 - delta waves, no eye or muscle activity
5 - REM (20%) - brain is electrically and metabolically active, increased eye movement, limb paralyzed, changes in blood flow, REM atonia prevents acting out dreams
location and time of biological clock
suprachiasmatic nucleus in hypothalamus
24.2 hour cycle
sleep requirements
infants - 20 h children - 10 teens - 9 adults 7-8 >50 - decrease by 27 minutes every decade
neurotransmitters in wakefulness
serotonin, NE, acetylcholine, dopamine, histamine, hypocretin/orexin (wakes us up in morning)
neurotransmitters in sleepiness
GABA, melatonin, adenosine
melatonin
avoid in pregnancy
likely effective
pharmacotherapy vs cognitive behavioral therapy for sleep
CBT superior to medication without concern of side effects and drug interactions
Use CBT in ALL patients EVERY night
jet lag
last 2-3 days (7-10 if greater than 8hr)
longer with eastward travel
