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103 Cards in this Set

  • Front
  • Back
which HA

bilateral

band like pressure

dental, cervical, visual corrections
tension HA
which HA:

unilateral

behind eye

15 min - 3 hrs

0.5% of population
cluster
which HA?

pulsating pain

periorbital

ice-pick like pai

unilateral

hours to days

10-20% of population
migraine
primary HA
tension

cluster

migraine
secondary ha due to:
organic causes:

hemorrhage

infection

stroke

tumor
which ha is bilateral
tension
which ha is behind eye?

periorbitial
cluster: behind eye

migraine: periorbital
which has ice-pick like pain
migraine
some triggers of migraines
stress

anxiety

hormonal

lack of sleep

chocolate

red wine

MSG

cheese
migraines possibly due to ----- ----- overactive
somatosensory cortex
what's thicker w/ migraines
somatosensory cortex
how long do migraines last
hours to days
what % of the pop has migraines
10-20%
migraines:

disorder of the ---- blood vessels
cranial
migraine involve --- and/or ---
5HT

NE
migraines may involve -----, ---, nad histamine sensitivities
glutamate

NO

histamine
majory excitable transmitter in the brain
glutamate
migrain involve ---- nerve sensory afferents
trigeminal (5)
in migraines initially there's --- then later ---- of bl vessels
contraction

dilation
phases of migraine
premonitory

aura

ha

postdrome
when can a migraine pt have the premonitory phase
hrs to days
what type of premonitory
psych

sensory

autonomic
aura include
visual

sensory

motory

language disturbances
migraine ha can last for
4-72 hrs
what's accompanied by ha
photophobia

phonophobia

sensory stimulation
postdrome can last up to
24 hrs
how do postdrome feel
euphoric

depressed

irritable
vascular theory --- followed by ----
vasoconstriction

vasodilation
spreading depresison theory

spreading wave of neuronal depolarization results in changes in --- --- and activates vascular responses, --- implicated
blood flow

glutamate
neurogenic model

neuronal --- w/ subsequent -- changes
dysfunction

vascular
neurogenic model:

there's a release of vasoactive ------
neuropeptides
vasoactive neuropeptides include
sub p


calcitonin gene related peptide

neurokin A
neuropeptides can cause vaso----, plasma -----, --- cell degranulation, --- inflammation
vasodilation

plasma extravasation

mast cell degranulation

neurogenic
ascending projections of ==== nerve activate --- pain centers
trigeminal

thalamic
in the neurogenic model --- nerve activated
facial (7)
what can cause the aura
cortical spreading depression
ineffective oral analgesics for acute tx include
asa

nsaids

apap
route of ketorolac
IM
what does ketorolac decrease
pain

nausea

photophobia
t/f

antiemetics just tx nausea associated w/ ha
t
antiemetic agents
cholorpromazine

metoclopromide

promethazine
ergots cause vaso----
constriction
route of ergotamine tartrate
oral

suppository
route of dihyroergotamine
nasal spray
ergots work by activating ------ receptors on vessels
5HT 1D/1B
ergots activated ---- 5HT 1D/1B receptors to decrease release in peptides causing pain, vasodilation, and inflammation
presynatpic
5HT 1B presynaptic inhibit --- ---- ----
vasoactive peptides release
5HT 1Dalpha decrease --- and ---- ----
locomotion

neurogenic inflammation
5HT 1DB cause -----
vasoconstriction
activation of 5HT 1D/1B receptors prevent activation of --- ----
trigeminal nerves
side effects of ergots
nausea

muscle weakness

pain
CI of ergots
vascular/coronary disease

hypertension

pregnancy

impaired renal and hepatic fx
why is ergot CI in pregnancy
decrease bl flow to fetus
why are ergots CI in vascular/coronary disease
too much vasoconstriction
route of sumatriptan
NS

SC

oral
bioavailabilty of sumtriptan oral
15%
route of zolmitriptan
oral

nasal spray
naratriptan has a long ---
t 1/2

bioavailable: 70%
which triptan has the highest bioavailabity
naratriptan

almotriptan
low triptan bioavailability
sumatriptan
triptans are 5HT --- ---- receptors agonists
5HT 1D/1B
MOA of triptans

activate 5HT 1D/1B receptors and . . .
vasoconstrict

prevent activation of trigeminal nerves
moa of triptans will also

activate presynaptic 5HT 1D/1B receptors and decrease
release of peptide causing pain, vasodilation, and inflammation
why's there a 40% recurrence w/ triptans
due to short t1/2

give ones w/ longer t 1/2: naratriptan and frovotriptan
triptan w/ difference in men and women bioavailability
frovotriptan
why might a pt experience cp w/ triptans
due to vaso constriction of bl vessels
triptans might cause:

--- aka lack of strenght/fatigue

nausea

somolence

dizziness

--- aka tingling or weird sensation in hands/fingers
asthenia

parathesia
triptans CI w/
coronary artery disease

MI

angina

MAOI and w/in 24 hrs of ergots
t/f

triptans more effective if given w/ ergot
f

don't give w/in 24 hrs

due to over vasoconstriction
what other med should be held for 24 hrs w/ triptans/ergots
methysergide. ..
5HT 2A/2C receptor antagonist. .. . prophylactic use med
why avoid MAOI w/ triptans
cuz they metabolize 5HT, so MAOI will prolong 5HT
opiaties are limited to --- or ---- HA
severe

intractable
t/f

opiates deal w/ cause and not pain
f

deal w/ pain and not cause
opiates are often combined w/ --- or ---
ASA

APAP
what has opiate like acitvity
tramadol
tramadol has mixed --- -------, inhibits ---, ---
u-agonist

NE

5HT
why should you limit frequency of any tx to 2 day/week
to prevent rebound HA
migraines that occur more than -- a month needs prophylaxis
2-3
migraines prophylaxis for attacks that last more than ---hrs and are ----
48

severe
migraine prophylaxis if --- tx provides little relief
acute
t/f

bb are used for acute relief
f

prophylaxis
which bb work best
lack of ISA

increase activity
how might bb work w/ migraine
block vasodilation

decrease 5HT release platelets
bb decrease -- and --- of migraines
severity

frequency
tricyclics used in migraines prophylaxis
amitriptyline

nortriptyline

protriptyline
t/f

ssri's may worsen migraines
t
ssri's sued in migraine prophylaxis
fluoxetine

paroxetine
ssri's effect --- and -- reuptake sites
NE

5HT
t/f

anticonvulsants can also be used for prophylaxis ha
t

topiramate

valproate/divalproex

gabapentin
what does topiramate block
Na

Ca channels

GABAa

AMPA

Kainate receptors
topiramate inhibits spreading ----
depression
topiramate decrease ---- activation
trigeminal
ae of topiramate
paresthesia

fatigue

cns depression

decrease appetite
how does valproate/divalproex work against migraines
effect early wave spreading depression
gabapentin decrease --- and --
Ca

glutamate
gabapentin can cause --- and ----
drowsiness

dizziness
methylsergide inhibits plasma --- and ---
extravasation

inflammation
botulism works best w/ this ha
tension
ARB that used as prophylaxis for migraine
candesartan
ACEI that's used as prophylaxis for migraine
Lisinopril
CCB can decrease ---

it has minimal effect on -----

more effective against ----
frequency

severity

aura
CCB used for migraine prophylaxis
verapamil
--- more effective in cluster HA
lithium