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30 Cards in this Set
- Front
- Back
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What are the Primary Headache Types?
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Migraine
Tension Cluster |
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What are the causes of Secondary Headaches?
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Underlying conditions:
lesion, tumor, vascular disorder, substance withdrawal, metabolic dx |
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Three possible treatments for Tension HA?
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Tylenol
NSAIDS Aspirin |
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What are the characteristics of Migraine HA?
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Unilateral, variable HA
Familial disorder More often in F:15-35y/o |
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Definition of an Aura
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Visual disturbance or loss of feeling in hand, tongue, or foot about 5-60min prior to HA.
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Characteristics of Classic Migraines?
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> 2 attacks w/ at least 3:
>= 1 reversible aura sx aura > 4 min aura sx < 60 min HA w/in 60min |
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Symptoms of migraines w/o aura
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Mod->severe intensity
Unilateral location Pulsating feature At least 1: N/V, photophobia, phonophobia |
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Characteristics of Migraine without aura?
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> 5 HA lasting 4-72 hr
At least two symptoms |
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What are the phases of migraines?
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1. Prodrome
2. Aura 3. Headache 4. Postdrome |
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What are some migraine triggers?
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stress
sunlight hypoglycemia exercise EtOH, CO excess caffeine or withdrawal estrogen, OC's, NTG |
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What is the action of Butalbital for acute migraines?
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Induces sleep
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What is the effect of caffeine for acute migraines?
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Increase absorption and synergy w/ analgesics
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What are non-pharm tx of migraines?
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Sleep
Quiet Ice Packs |
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What are some narcotic tx for acute migraines?
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Fiorinal (ASA, butalbital, caffeine)
Fioricet (APAP, " ") Fiorinal w/ Codeine Fioricet w/ Codeine |
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Name some NSAIDS that can be used for mild-moderate migraines.
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Ibuprofen
Diclofenac Flurbiprofen Ketorolac Naproxen |
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MOA for NSAIDS in acute migraines
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Decreases inflammation in trigeminovascular system in inhibiting prostaglandin synthesis.
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What are the 1st and 2nd generation Triptans?
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1st: sumatriptan
2nd: rizatriptan, zolmitriptan, naritriptan, almotriptan, eletriptan, frovatriptan |
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What formulations of triptans are available?
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Oral - works in 2-4hrs
Nasal Spray - works in 2hr SubQ - works in 2hr |
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Dosing/Interactions for triptans
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Limit < 2 days/wk -> rebound HA.
Avoid MAOI's w/in 2wks Avoid ergotamine w/in 24hr |
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MOA of triptans
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Selective agonist of 5-HT receptors-> intracranial vasoconstriction, interrupt pain xmission in brain stem
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Ergotamine
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MOA: alpha-adrenergic antagonist, non-selective 5-HT agonist; vasoconstrict cranial vessels.
Dose: early during HA, use < 2d/wk |
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Contraindications of triptans and ergotamine
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CAD, PVD, uncontrolled HTN, cerebrovascular dx
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DOC for N/V in migraines
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Metoclopramide
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What are the indications for migraine prophylaxis?
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Recurring disabilities
Attacks > 2x/wk Not responding to meds Hemiplegic or basilar migraines |
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What are the drug classes for migraine prophylaxis?
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Beta blockers
TCAs SSRIs MAOIs CCBs NSAIDs Divalproex Topiramate |
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What are the 1st, 2nd and 3rd line agents for migraine prophylaxis?
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1st line: BB-Propranolol, TCA-amitriptyline
2nd line: SSRI-fluoxetine 3rd line: ""-paroxetine, sertraline, fluvoxamine |
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What is a cluster HA?
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Short, severe, episodic, uniltateral stabbing intenses pain over eyes & forehead; lasts days-wks.
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Who are effected by cluster HA?
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Males:Females - 6:1
Usually 20-40 y/o <1% of pop. No family hx |
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What are some cluster HA treatments?
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O2 (1st line)-> rapid cranial vasoconstriction
Sumitriptan Ergotamine Lidocaine 4% spray Corticosteroids |
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What are cluster HA prophylaxis tx?
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Indomethacin
Valproate Verapamil Lithium Prednisone (Last choice) |
