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38 Cards in this Set

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What is the only type of HA more common in men?
cluster
What are the three "common HA types"?
tension
migraine
cluster
What other symptoms are cluster HAs associated with?
ipsilateral tearing and rhinorrhea
What three things might you suspect in a worsening HA pattern?
mass lesion
subdural hemorrhage
medication overuse HA
What might papilledema suggest?
intercranial mass lesion
pseudotumor cerebri (aka benign intracranial htn)
encephalitis
meningitis
Why are many oral agents ineffective for abortive migraine therapy?
poor absorption secondary to migraine-induced gastric stasis
What works better for migraines, single large dose or repetetive small doses?
single large dose
What drugs should be used as abortive tx for mild-moderate migraine pain?
NSAIDS/APAP 600-800/10000
Name the triptans.
sumitriptan
rizatriptan
zolmitriptan
almotriptan
elitriptan
naratriptan
frovatriptan
Which triptans are available in a formulation besides a pill?
sumitriptan
rizitriptan
zolmitriptan
What is the MOA of triptans?
selective agonist for seratonin receptors (5-HT1B,D, and F) --> causing vasoconstriction

they also inhibit transmission to trigeminal nucleus caudalis, blocking afferent input to second order neurons

They also may activat dHT1b/1d receptors in descending pathway to inhibit dural nociception
Why don't the seratonin antagonist nausea meds interfere with triptans?
they affect the 3type receptor in the gut instead of the 1type receptor in the cranial arteries
Why shouldn't triptans or ergot-containing drugs be used within 24h of each other?
ergots prolong vasospastic rxns (vasocontriction can be additive)
What drugs besides ergots interact w/triptans?
MAOIs (avoid w/in 2 weeks of d/c MAOI)

SSRIs
SNRIs
Which triptan is a 3A4 substrate?
Eletriptan
(zolmitriptan?)
propranolol and verapamil will inc serum concentrations
What are the common SEs of SC sumitriptan?
injection site rxn, chest pressure, flushing, weakness, drowsiness, dizziness, malaise, paresthesias
- reports of MI/SCD
In which pts should triptans be avoided?
ischemic stroke
ischemic heart disease
prinzmetal's angina
uncontrolled htn
PREGNANCY
Which pts should recieve the 1st dose of triptan under med supervision?
those with risk factors but no known CHD
(men>40, postmenopausal women, DM, hypercholesterolemia, HTN)
Why aren't ergots very useful?
poorly absorbed
may worsen nausea
REBOUND HA
may be associated w/valvular heart disease
What is the MOA of ergots?
5HT1b/d agonists
partial agonist and/or antagonist against tryptaminergic, dopaminergic and alpha-adrenergic receptors depending on their site

--> constriction of peripheral/cranial blood vessels
What are the cytochrome interactions of ergots?
3A4 substrate
What drugs are ergots contraindicated with?
erythromycin, ritonavir, itraconazole, triptans

and beta blockers will inc vasospasm risk
What association is there with prolonged ergot use?
valvular heart disease
pleuropulmonary fibrosis
What is the new form of ergotamine?
dihydroergotamine
What is dihydroergotamine often given with (especially when used IV)?
antiemetic (prochlorperazine)
What is the MOA of dihydroergotamine?
alpha-adrenergic blocker that directly stimulates vascular smooth muscle to vasocontrict peripheral/cerebral vessels

also affects serotonin receptors
WHat are the cytochrome interactions of dihydroergotamine?
substrate of 3A4 (same as original ergotamines - same precautions)
Why is dihydroergotamine preferrable to original ergot?
fewer SEs (just rhinitis if nasal spray, and nausea if IV)

no physical dependence
no rebound HAs

*but still CI in pts with HTN/CHD
Which two antiemetics can be used as monotherapy for migraine?
IV metoclopramide
IV/IM chlorpromazine and prochlorperazine

NOT ORAL
What drugs have been shown to have some effect on migraine prevention?
BBs (best evidence)
CCB (minimal)
ACEI
ARB
Which two beta blockers are FDA approved for migraine prophylaxis?
propranolol
timolol
Which other BB may be used for prophylaxis?
atenolol, nadolol, metoprolol
Which CCB is usually used for migraine prophylaxis (even though evidence is weak)?
verapamil
What is the main problem with CCBs for migraine prophylaxis?
tolerance often develops w/in a few months
WHich anticonvulsants are FDA approved for migrain prophylaxis? Which other one is often used?
VPA and topiramate are approved; gabapentin may be used
WHich TCA has proven efficacy for migraine?
amitriptyline
What are the tx options for cluster headaches (abortive tx)?
100% O2***
SQ/intranasal sumitriptan
Octreotide
intranasal DHE
What drugs may be used for cluster HA prevention?
verapamil
prednisone