Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
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% |