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76 Cards in this Set
- Front
- Back
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what is a monoamine oxidase inhibitor that is used for the tx of headaches
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phenelzine
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what is a serotonin receptor antagonist that is used for tx of headache
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mirtazapine
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what are some antiepileptic agents
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topiramate, gabapentin, valproic acid, depakene
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what is an ergot used for HA
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methysergide
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what are four drugs that are used as adjuvant symptom relief
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indothmethacin- for inflammation, prednisone- for inflammation, metoclopramide ( for vomiting),prochlorperazine (nausea)
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which cranial structures are pain producing
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falx cerebri, middle meningeal artery, scalp, dural sinuses, prox segments of large plial arteries
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what are the most common types of primary headaches
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migraines, tension type, cluster
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where are most migraines felt
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u/l in most or global in some
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where are tension ha felt
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b/l head band config
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where are cluster ha felt
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u/l always, usually begins around the eye or temple
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what are characteristics of cluster ha
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pain begins quickly, it is explosive, deep, continuous, reaches a cresendo within minutes, where as a migraine is a gradual pain
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when do most migraines occur and how long do they last
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early morning and last 4-72 hours
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when do cluster ha occur
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night time
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when do tension ha occur
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daytime
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what are some assoc symptoms with migraines
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photo and phonophobia, nausea, vomititng, they may have aura
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what are some assoc symptoms with cluster ha
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i/l lacrimation and redness of the eye, stuffy nose, rhinorrhea, pallo and sweating
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what sex gets cluster ha more
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male
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what sex gets migraines and tension ha more
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females
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what could the sensory sensitivity of migraines be assoc with
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monoaminergic sensory control systems located in the bs and thalamus
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what NTs are involved with migraines
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serotonin and dopamine
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what does treatment of migraines with selective serotonin receptor agonist do
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normalizes cranial CGRP levels---also a high affinity antagonist for CGRP are effective and well tolerated tx
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what mutation is assoc with familial hemiplegic migraine
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voltage gated calcium channel gene (CACNA1A), ATP12 gene, SCN1a- neurolonal voltage gated na channel suggest alterations in membrane excitability
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what is aura
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visual symptoms of migraines (flashes of light, blank area in the field of vision, zigzag patterns, they typically precede the migraine
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what can manage TTH
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NSAIDS, aspirin, acetometaphen
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what is the only proven treatment for chronic TTH
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Amitriptyline
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what is the timing of cluster ha
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at least one daily attack of pain recurs at the smae hour each day for the duration of a cluster bout which lasts 8-10 weeks and is usually followed by a pain free interval that averages one year
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what part of the brain does cluster HA involve
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central pacemaker neruons on the region of the posterior hypothal
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what are common headaches treated with
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acetometaphen and NSAIDS_aspirin, ibuprofen, naproxen
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what are some combination products that are used for moderately severe to severe headaches that are unresponsive to nsaids or acetometaphen
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1. butalbial, acetominophen, caffiene
2. butabial, aspirin, caffeine 3. aspirin, aceto, caffeine excedrine migraine 4. aceto, caffeine- excedrine tension |
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what is the MOA of butabital
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increases GABAa channel opening time when present at the channel with GABA
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what are some se for butalbital
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abuse and toleranve, cns depressant
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what do triptans treat
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migraines
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what are SE and contraindications of triptans
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SE: parathesiasm asthenia, fatigue, flushing, feeling of pressure, tightness or pain in the chest, neck, jaw, drowsiness,dizziness, nausea and sweating
contraindications: cause vasospasm and so not for ppl with CAD and angina |
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what are the SE of sq injection of sumatriptan
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reactions at injxn site and bitter taste from the nasal prep
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what are sumatriptan, rizatriptan, and zolmitriptan contraindicated for
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pts taking MOA inhibitors
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what is the MOA of ergot and ergot alkaloids
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agonist and patial agonist and antagonist at alpha adrenergic and serotonicn receptors, agpnist and partial agonist actions at the CNS dopamine rescpetos they can bind to pre and post junctional receptors
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why do ergo and ergot alkaloids have low bioavailability
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extensive metab by liver, poor oral absorption, high first pass metab
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what is the half life of ergotamine
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2 hours but vasoconstriction last for up to 24 hours
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what makes dihydroergotamine diff than ergotamine
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is eliminated more rapidly than ergotamine and has a shorter vasoconstricting effects
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what is the reason that ergots tx migraines
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they cause constriction of vas smoooth muscle ( blood vessels
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what are side effects of ergots
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nausea, vom (direct effect on CNS emetic centers, leg weakness, muscle pains, numbness adn tingling of fingers and toes
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what do toxic doses or ergot caues
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vasospasm, which may lead to lib gangrene and bowel infarction
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who are ergots contraindicated in
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preg women, or trying to be preg, htn, periph vas diz, CAD, impaired hepatic and renal
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what does abrupt discontinuation of ergots cause
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rebound HAs
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what are two dopamine antagonist
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metaclopramide and prochlorperazide
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what is oral dopamine antagonist do as an adjuvant therapy for migraine
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decrease nausea and vom and increase gastric absorption
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what is the prototype of b adrenergic receptor antagonist that is used for migraine
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propanolol - time to onset of migraine prophylaxis is several weeks
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what is the prototype of calcium channel blockers that is used to tx migraines
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verapamil
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what is the MOA of verapamil
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inhibits ca entry from select voltage sensitve areas of vascular smooth muscle, which produces relaxations of vasc smooth musc and vasodilation
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what is oral dopamine antagonist do as an adjuvant therapy for migraine
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decrease nausea and vom and increase gastric absorption
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what are the most commonly used tricyclic antidepressants used to treat migraines
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amitriptyline, nortriptyline, imapramine, doxepin, protriptyline
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what is the prototype of b adrenergic receptor antagonist that is used for migraine
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propanolol - time to onset of migraine prophylaxis is several weeks
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which TCA is used most often for migraine prophylaxis
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amitriptyline
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what is the prototype of calcium channel blockers that is used to tx migraines
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verapamil
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why do you take tca in evening
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bc its sedating
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what is the MOA of verapamil
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inhibits ca entry from select voltage sensitve areas of vascular smooth muscle, which produces relaxations of vasc smooth musc and vasodilation
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what is the MOA of Mirazapine
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causes potent blockade of 5ht 2 and 3 receptors, but does not show high affinity for 5ht1a and 5ht1b receptors-
--> used for migraine prophylaxis and treatmend of depresion overall its has low efficacy for prophalaxis of migraines |
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what are the most commonly used tricyclic antidepressants used to treat migraines
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amitriptyline, nortriptyline, imapramine, doxepin, protriptyline
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which TCA is used most often for migraine prophylaxis
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amitriptyline
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why do you take tca in evening
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bc its sedating
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what is the MOA of Mirazapine
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causes potent blockade of 5ht 2 and 3 receptors, but does not show high affinity for 5ht1a and 5ht1b receptors-
--> used for migraine prophylaxis and treatmend of depresion overall its has low efficacy for prophalaxis of migraines |
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what is Topiramate used for
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the treatment of migraine ha and prophylaxis as well as seizure disorders
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what properties does topiramate have that allow it to work for two purposes
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blocks volatage gated na channels, activates hyperpolarizing k currents and enhances postsynaptic GABAa receptor currents and antagonizes AMPA kainate subtypes of glutamate receptors
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what interaction does topiramate have with estradiol
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it reduces plasma concentratins and ay require the need for higher doses of oral contraceptives when coadministered
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what are the adverse effects of topiramate
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solnolence, fatigue, weight loss, and nervousness
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what is Gabapentin used for
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to treat and prophylaxis of migraine, also treat seizure and vasomotor symtoms. it has a shorter half life than topiramate
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what are the side effects of gabapentin
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somnolence, dizziness, ataxia, and fatigue..they usually subsie after two weeks of continued therapy
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what is valproic acid used for
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prophylaxis of migraines and the treatment of seizure disorder, bipolar disorder, and schizophrenia
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what is the moa of valproic acid
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interferes with both NMDA and GABA
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what are side effects of valproic acid
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transient GI probs ( anorexia, nausea, and vomiting) sedation, ataxia, and tremor...more rare SE: pancreatitis, hyerammonemia, teratogenic effects, and fulminant hepatitis
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what is the moa of methysergide and what is it used for
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ergot derived that is a mixed agonist and antagonist on serotonin receptors
used for the prophylaxis of migraines but not for an acute attack |
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what is a SE of merysergide
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inflam fibrosis and dependence which requires treatment interuption for three weeks or more every six months of therapy
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what is botulinum toxin A used for
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to abort or prevent migraine recurrence if other treatments fail
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what drug is mostly used to treat tension head aches
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amitriptyline- tricyclic antidepressant
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what is the abortative agent used to treat cluster headache
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sumatriptan
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what are the preventative agents used for cluster headaches
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verapamil, prednisone, indomethacin, topiramate, frovatriptan
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