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30 Cards in this Set

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