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33 Cards in this Set

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Who has more headaches - men or women?
Women (3:1)over men
What is the age of peak prevalence?
25 to 55 years old. Absolute peak at age 40
What are associated medical disorders
Epilepsy, Stroke (women <45yo), Raynaud's, Asthma, depression, anxiety, panic, bipolar
What are barriers to proper migraine treatment?
1. Comes up as after thought at MD appt.
2. Clinicians focus on R/O 2ndary causes
3. Step care = patients lose interest.
Describe the 6 steps of migraine induction.
1. Neural dysfunction
2. Cascade
3. Vasodilation
4. Trigeminal nerve activation
5. Vasoactive neuropeptide release
6. Exacerbation of vasodilation
What are the 2 mechanisms of action for triptans?
1. Bind blood vessels to decrease vessel inflammation (5HT-1b)
2. Bind never terminals to prevent release of neuropeptides (5HT-1d)
Migraine is a loss of (a)_______ and inability to (b) ______.
(a) central inhibition
(b) accommodate various stressors
What are the four phases of migraine?
1. premonition/prodrome
2. Aura (optional)
3. Headache
4. Postdrome
Prodrome:
- prevalence
- general symptoms(9)
- 60% experience it
- elation, irritability, depression, neck stiffness, food craving, fluid retention, thirsty, drowsy
Aura:
- prevalence
- cause
- symptoms
- duration
- 15% experience it
- cortical/brainstem dysfunction
- visual hallucinations or tingling. Also, speech or motor problems
- lasts 20-60 min. Usually ends before HA, but may persist
Migraine Headache:
- describe pain
- associated symptoms
Pain:
Generally unilateral, throbbing (can be bilateral)

Associate Symptoms:
N&V, photophobia, phonophobia, osmophobia

Resolution with sleep
Postdrome:
Symptoms
Mood changes
muscle weakness
physical tiredness
down appetite
A
U
S
T
I
N
A - Aggrevated by activity
U - unilateral
S - Sensitivity to light/sound/smell
T - Throbbing
I - Intensity is mod to severe
N - Nausea and vomiting
What are the red flags in HA Hx?
Age of onset >45 yo
Time from onset to peak pain
Pain >5
Aggravating factors
Associated symptoms
Name 2 Migraine Disability Assesments
Headache Impact Test (HIT-6)
Migraine Disability Assessment Scale (MIDAS)
Is Step Care or Stratefied Care preferred?
Stratefied.
Describe the stratefied care approach
Uses assessments to determine disability/severity. Initial treatment is based off of need.
What are some non-pharmacologic strategies to treating migraine?
Biofeedback
relaxation therapy
cold compress
sleep
rest
HA diary
Accupuncture
Alternative Meds:
Feverfew
Mg
Riboflavin
CoQ-10
valerian root
Omega-3's
Goals of acute treatment
rapid relief
consistent relief
no recurrence
minimize use of rescue meds
cost-effective
avoid SE's
Specific migraine meds
triptans
ergotamine
Non-specific migraine meds
Acetaminophen/aspirin/caffeine
aspirin
ibuprofen
naproxen
Rescue meds (common opiates)
butorphanol
acetaminophen with codeine
Common antiemtics
metoclopramide - favorite (up GI motility too!)
chlorpromazine
prochlorperazine
Goals of acute treatment
rapid relief
consistent relief
no recurrence
minimize use of rescue meds
cost-effective
avoid SE's
Specific migraine meds
triptans
ergotamine
Non-specific migraine meds
Acetaminophen/aspirin/caffeine
aspirin
ibuprofen
naproxen
Rescue meds (common opiates)
butorphanol
acetaminophen with codeine
Common antiemtics
metoclopramide - favorite (up GI motility too!)
chlorpromazine
prochlorperazine
5HT receptors involved in:
-Treatment
-Prevention
-N&V
Treatment = 5HT-1b, 1d
Prevention = 5HT-2
N&V = 5HT-3
Ergot derivatives
- Agents (2)
- interact with receptors
- ADEs
-Available forms
Agents:
ergotamine, dihydroergotamine (DHE)

Receptors:
5HT-1, alpha & beta adrenergic, DA, 5HT-3

ADEs:
N&V, diarrhea, excessive vasoconstriction

Available forms:
spray, injection
Are melt-tabs faster or slower onset?
Slower!
Contraindications for TRIPTANS
-Heart disease
- Uncontrolled hypertension
- pregnancy (cost/benefit)
- hepatic impairment
Triptan Drug interactions
- W/in 24h of ergot use
- W/in 2 wks of MAOI use
- SSRI's (including St. John's wort) -->serotonin syndrome
- Oral contraceptive = potential triptan increase
Specific:
propanolol and rizatriptan --> increase rizatriptan conc by 70%