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69 Cards in this Set
- Front
- Back
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What are the two classifications of headaches by the International Headache Society?
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1. Primary Headache
2. Secondary Headache |
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What are the three types of primary headaches?
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1. Tension
2. Cluster 3. Migraine |
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Describe a tension headache:
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Bilateral
Band-like pressure Can get after dental, cervical or visual corrections. |
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Describe a cluster headache:
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Unilateral
Behind Eye Lasts 15 minutes - 3 hours Affects 0.5% of the population |
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Describe a migraine headache:
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Unilateral
Pulsating pain Periorbital Ice-pick-like pain Lasts hours to days Affects 10-20% of population |
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What are some secondary causes of headache?
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1. Hemorrhage
2. Infection 3. Stroke 4. Tumor |
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What is the percent incidence of migraines in males, females, and children?
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Males - 6%
Females - 18% Children - 4% 23-23 million affected |
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How many office visits a year are attributed to migraines? How many workdays a year are lost?
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10 million office visits/year
Major economic impact due to medical costs and lost worker productivity (64 million workdays/year lost) |
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How does Brenner describe a migraine in Pharmacology 2000?
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Neurovascualr dysfunction caused by imbalance of excitatory and inhibitory activity at various levels of the CNS, triggered by hormones, stress, fatigue, hunger, circulating food or drug derived substances.
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What are eight possible triggers of migraines?
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1. Stress
2. Anxiety 3. Hormonal 4. Lack of sleep 5. Chocolate 6. Red wine 7. MSG 8. Cheese |
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Used to be believed that migraines were purely vascular, what are the newer suggestions?
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It's a neurological disease and people who get repeated migraines actually have a thicker somatosensory cortex.
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What are four elements involved with migraines?
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1. Disorder of cranial blood vessels
2. Involvement of 5HT and/or NE 3. May involve glutamate, NO, and histamine sensitivities 4. Trigeminal nerve (V) sensory afferents |
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What are the four phases of a migraine?
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1. Premonitory
2. Aura 3. Headache 4. Postdrome |
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What percentage experience a premonitory phase?
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60%
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How far in advance will the premonitory phase be?
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Hrs/days
It can be pyschological, sensory, or autonomic |
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What percentage of migraine sufferers experience an aura?
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20%
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What are four different representations of aura?
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1. Visual
2. Sensory 3. Motor 4. Language disturbances |
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How long does the headache phase last?
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4-72 hours
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What three symptoms do most people with migraines experience during the headache phase?
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1. Photophobia
2. Phonophobia 3. Sensory Stimulation |
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How long does the postdrome phase of a migraine last?
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up to 24 hours
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What are three different moods associated with the postdrome phase?
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1. Euphoric
2. Depressed 3. Irritability |
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What was Wolf's theory of the migraine?
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Rapid vasoconstriction followed by extensive vasodilation
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What was Olesen's theory of the migraine?
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Spreading wave of neuronal depolarization results in changes in blood flow and activates vascular responses, glutamate implicated
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What is Moskowitz's theory of the migraine?
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1. Neuronal dysfunction with subsequent vascular changes.
2. Release of vasoactive neuropeptides - Substance P, Calcitonin gene related peptide, Neurokinin A, causing vasodilation, plasma extravasation, mast cell degranulation, neurogenic inflammation 3. Ascending projections of trigeminal nerve activate thalamic pain centers 4. Facial nerve (VII) activated |
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What is the acute treatment for mild to moderate migraine?
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1. Oral analgesics (Aspirins, NSAIDs, Acetaminophen not effective) - Ketorolac IM decreases pain, nausea, and photophobia
2. Antiemetic agents (Chlorpromazine, Metoclopromide, Promethazine) - just treat nausea associated with headache |
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What are three medication options for treating moderate to severe migraines?
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1. Ergots
2. Triptans 3. Opiates |
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What are ergots?
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Ergots are vasoconstrictors
Fungus from rye referred to as "black death" or St. Anthony's fire |
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What are two Ergots and what are their dosage forms?
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1. Ergotamine tartrate - oral or suppository
2. Dihydroergotamine - nasal spray |
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What are the three mechanisms of action of Ergots?
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1. Activate 5HT1D/1B receptors on vessels - vasoconstrictors
2. Activate presynaptic 5HT1D/1B receptors - to decrease release of peptides causing pain, vasodilation, and inflammation 3. Activate 5HT1D/1B receptors prevent activation of trigeminal nerves |
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What are the three side effects of ergots?
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1. Nausea
2. Muscle weakness 3. Pain |
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What are the four contraindications of Ergots?
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1. Vascular/Coronary disease
2. Hypertension (relative contraindication) 3. Pregnancy 4. Impaired renal or hepatic function |
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What are triptans?
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5HT1D/1B receptor agonists
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Name 7 triptans.
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1. Sumatriptan
2. Zolmitriptan 3. Rizatriptan 4. Naratriptan 5. Almotriptan 6. Frovotriptan 7. Eletriptan |
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What are the four mechanisms of action for triptans?
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1. Activate 5HT1D/1B receptors on vessels - vasoconstriction
2. Activate presynaptic 5HT1D/1B receptors - decrease release in peptides causing pain, vasodilation, and inflammation 3. Activation of 5HT1D/1B receptors - prevent activation of trigeminal nerves 4. Effective in 85% of patients, 40% recurrence same day (sumatriptan) - decreased with longer acting agents (Frova and Amerge) |
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What are the six side effects of triptans?
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1. Chest symptoms - tightness, pressure, and pain
2. Asthenia (lack or loss of strength and energy) 3. Nausea 4. Somnolence (state of near sleep) 5. Dizziness 6. Parethesia (sensation of tickling, tingling, burning, pricking, or numbness) |
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What are the four contraindications of triptans?
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1. Coronary artery disease
2. MI angina 3. MAO inhibitors within 24 hours of ergots 4. Methysergide |
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What are opiates limited to?
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Opiates are limited to severe or intractable headaches
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What are opiates often combined with?
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1. aspirin
2. acetaminophen |
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What is Tramadol?
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It is an opiate that is a mixed mu-agonist which inhibits uptake of NE, 5HT
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Why should the frequency of opiates be limited to 2 days/week?
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To prevent rebound headahe
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What are four reasons to consider migraine prophylaxis?
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1. Migraines occur more than 2-3 times a month
2. Attacks last more than 48 hours 3. Attacks are severe 4. Acute therapy provides little relief. |
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What are the eight types of medications used for migraine prophylaxis?
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1. B-Blockers
2. Anticonvulsants 3. Botulinum toxin 4. Antidepressants 5. ARB 6. ACEI 7. CCB 8. Lithium |
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Which five BB are used in migraine prophylaxis?
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1. Propanolol
2. Timolol 3. Nadolol 4. Metoprolol 5. Atenolol |
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What do these BB lack that increases activity?
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ISA
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What is the mechanism of BB in migraine prevention?
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The mechanism is not completely understood. BB may block vasodilation and decrease 5HT release from platelets
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What are the three types of anticonvulsants used in migraine prophylaxis?
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1. Topiramate
2. Valproate/Divalproex 3. Gabapentin |
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What is the mechanism of action of Topiramate?
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Topiramate blocks sodium, calcium channels, GABAa, and AMPA/kainate receptors, inhibits spreading depression, and decreases trigeminal activation
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Which anticonvulsant is becoming a first line agent in migraine prophylaxis?
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Topiramate
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What are the four adverse effects of Topiramate?
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1. Paresthesia (Prickling or burning sensation)
2. Fatigue 3. CNS depression 4. Decreased appetite |
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What is another anticonvulsant, besides Topiramate, being used in migraine prevention?
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Gabapentin
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What is Gabapentin and what does it do in the body?
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Gabapentin is an antiepileptic that decreases Calcium and decreases glutamate.
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What are the two main side effects of Gabapentin?
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1. Drowsiness
2. Dizziness |
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What did the FDA approve October 15th, 2010 as treatment for migraine prophylaxis?
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Botulinum Toxin
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When is botulinum toxin used for migraine prophylaxis?
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Botulinum toxin is used in patients with 15 or more days of migraine headaches per month.
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How many fewer headaches in what amount of time do people using Botulinum toxin for migraine prophylaxis have?
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2 fewer headaches per month
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How is botulinum toxin adminstered?
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Botulinum toxins are given in the head and neck as injections every 12 weeks to reduce headaches.
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What are the two type of antidepressants used for migraine prophylaxis?
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1. Tricyclics
2. SSRI's |
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What are three tricyclic antidepressants used for migraine prophylaxis?
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1. Amitriptyline
2. Nortriptyline 3. Protriptyline |
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Which two SSRI's are sometimes used for migraine ptophylaxis?
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1. Fluoxetine
2. Paroxetime |
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True/False: SSRI's are the most used medication for migraine prophylaxis.
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False
SSRI's not frequently used because they may worse the migraine |
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How do antidepressants contribute to migraine prophylaxis?
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Antidepressants affects NE and 5HT reuptake sites
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What is an ARB used for migraine prophylaxis?
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Candesartan
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What is an ACEI used for migraine prophylaxis?
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Lisinopril
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What is a Calcium channel blocker used for migraine prophylaxis?
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Verapamil
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True/False: CCBs have limited used for migraine prophylaxis
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True
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How do CCBs work for migraine prophylaxis?
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CCB's decrease the frequency of the migraines and have a minimal effect on severity. It is more effective against aura.
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Which type of headache is lithium used for?
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Cluster
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Which receptors are the Somatodendritic autoreceptors?
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5-HT1a
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Which receptors are the Presynaptic autoreceptors?
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5-HT1d/1b
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