-
What are the characteristics of a tension HA?
- constant tight pressure
- "hatband" distribution
- NO throbbing
-
What are the characteristics of a tumor HA?
- steady, aching pain
- may have acute onset
-
What are the characteristics of a subarachnoid hemorrhage HA?
- sudden, severe pain
- "worst headache of my life"
-
Which gender is more likely to have at least 1 migraine per year?
women
-
Before age 12, which gender has more migraines?
boys
-
What comorbidities are sometimes associated with migraine?
- stroke
- IBS
- HTN
- depression
- anxiety disorder
- epilepsy
-
What neurotransmitters are involved in migraine?
- 5-HT
- DA
- GABA
- NMDA
- calcitonin gene-receptor peptide
-
How long do migraines last?
4-72h
-
What is a migraine hangover?
- fatigue
- irritability
- weakness
- euphoria
- scalp tenderness
- anorexia
- may last 1-2d
-
What are the non-pharmacologic tx for migraine?
- quiet, dark rooms
- ice packs
- avoidance of triggers
- regular sleep
- exercise
- eating habits
- behavioral intervention
-
You need at least 2 of what symptoms to diagnose migraine?
- unilateral location
- pulsating quality
- moderate or severe intensity
- aggravation by (or avoidance of) routine phys activity
- during the headache:
- n/v (or both)
- photophobia
- phonophobia
-
What should be considered when choosing abortive tx of migraine?
- associated sx - N,V
- CI
- comorbidities
- pt response to previous tx
- pt acceptance of tx/rte of administration
-
When may abortive tx alone be appropriate?
- pt experiences <2 attacks/mo
- pt has CI to preventive tx
-
What drugs are used for abortive tx of migraines?
- triptans
- ergot alkaloids
- VPA
- metoclopromide
- phenothiazines
- buterophenones
- magnesium sulfate
- CCB
- antihistamines
- lidocaine
- skeletal muscle relaxants
- Telcagepant
-
Which drugs are the DOC for abortive tx of migraine?
serotonin receptor agonists (triptans)
-
How long does it usually take for a triptan to be effective?
2hrs
-
What are the SE of triptans?
- paresthesias
- tingling sensations
- burning or warm sensations
- flushing
- dizziness
- somnolence
- fatigue
- N,V
- transient increased BP
- pain, pressure, tightness or heaviness of chest, neck, and/or jaw (SQ sumatriptan the most)
- MI
- death
-
What are the CI of the triptans?
- CAD
- uncontrolled HTN
- arrhythmias
- PVD
- hx of stroke or TIA
- pregnancy
-
Which ergot alkaloid comes in an injectable form?
dihydroergotamine mesylate (DHE)
-
What are the SE of ergot alkaloids?
- leg cramps
- tingling
- stiffness
- numbness in the exptremities
- ergotism (severe vasoconstrictive crisis)
- sedation
- depression
- fatigue
- rhinitis, congestion, taste disturbances (intranasal DHE)
-
What are the CI of ergot alkaloids?
- pregnancy
- nursing
- caution in HTN
-
What is the role of VPA in abortive tx in migraine?
- refractory pts
- CI to triptans or ergots
-
Why are phenothiazines and butyrophenones used in abortive tx of migraine?
- sedative and antiemetic properties
- for pts who cannot tolerate triptans or ergots
-
What is status migrainosus?
- HA lasting > 72hrs despite tx
- includes severe head, neck, or face pain; GI sx, insomnia
- often requires hospitalization
-
What is the tx for status migrainosus?
- DHE or triptans
- narcotic analgesics
- IV phenothiazines
-
What criteria should be met to treat prophylactically for migraine?
- excesive abortive usage (at least weekly use of abortives)
- 2 or more migraines/month with >48hr duration and severe intensity
- ineffective or CI to abortive tx
-
How long should you use a drug for migraine before changing it to something else?
2-3 months minimum
-
When should you think about discontinuing migraine medication?
if controlled for 3-6 months
taper the drug
-
What are the agents for prophylactic tx for migraines?
- beta blockers DOC
- TCAs (AD DOC for migraine)
- anticonvulsants
- CCB (verapamil)
- ACE/ARB
- NSAIDS
-
Which NSAID is the best for menstrual migraine prophylaxis?
naprosyn
-
What are the first line drugs for migraine prophylaxis?
- amitriptyline
- divalproex sodium
- propranolol
- timolol
-
What are the combinations used in migraine prophylaxis?
- beta blocker with TCA
- CCB and TCA
- CCB and ergot derivatives
- beta blocker, TCA or CCB with NSAID
-
What is a menstrually related migraine?
- no aura
- occur 2 days before to 3 days after menstruation
- at least two of three menstrual cycles
- (if exclusively during menstruation = pure menstrual migraine; if not, then = menstrually related migraine
-
What drugs should be used in kids with acute migraine?
- ibuprofen
- apap
- sumatriptan nasal spray
- oral triptans (no data)
-
What drugs should be used in kids for migraine prophylaxis?
- propranolol DOC
- flunarazine
- cyproheptadine
- amitriptyline
- divalproex sodium
- topiramate
- levetiracetam
-
What is the acute treatment for tension headache?
- ASA
- simple combinations
- NSAID > APAP
limit to 2-3 d/week or can get analgesic rebound headaches
-
What is the preventative treatment for tension headache?
- amitriptyline (+/- tizanidine)
- mirtazapine
- SSRI and botulism have NO EFFICACY
-
What are the features of cluster headaches?
- intense piercing-throbbing pain
- STRICTLY unilateral
- up to 8/d
- usually around 1 hr duration (15-180 min)
- often occur 1-2 h after falling asleep or in early a.m.
- accompanied by autonomic symptoms (tearing, runny nose)
- patients are restless and pace or sit and rock
- pts tend to be aggressive
- average clustering lasts 4-8 wks
-
What are the acute treatments for cluster HA?
- sumatriptan
- zolmitriptan
- lidocaine
-
What are the preventative treatments for cluster HA?
- verapamil
- Li
- corticosteroids
- topiramate
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