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Flashcards in Headache Deck (29)
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1

Acute nonpharmacologic treatments of tension type headache

-Heat
-Ice
-Massage
-Rest
-Biofeedback

2

What is the goal for limiting acute treatment of TTH?

-Less than 9 days/month
-Max of 2 doses/day

3

Initial monotherapy of TTH (outpatient)

What about inpatient?

-Oral ibuprofen (200 or mg)
-Naproxen (375 mg or 550mg)
-APAP 1000mg once


Inpatient centers may give one dose of ketorolac

4

Combination analgesic used for TTH

Excedrin (caffeine + APAP + ASA)

5

What is the most helpful tool to assess HA pattern and response to tx for migraine patients?

Headache diary

6

Non-pharm treatments of Migraines

Abortive: Relaxation techniques, ice massage

Prophylactic: Regular exercise, relaxation techniques, stress management, biofeedback, acupuncture, PT, diet

7

Why are many oral agents ineffective in migraines?

Poor absorption secondary to migraine-induced gastric stasis

8

When are migraine specific agents indicated?

-Moderate to severe migraine symptoms and in those whose HA's respond poorly to NSAIDs

-Use non-oral route if early S/S with N/V

9

What medication classes are used for Mild-Moderate migraines?

-NSAIDs +/- APAP
-ergots
-"Triptans" ***
-"gepants"
-"ditans"

10

What drug is used as an acute adjunctive tx for patients with N/V?

-IV dopamine antagonism
-metoclopramide, prochlorperazine, promethazine

11

Which class of medications is an agonist on many serotonin receptors? Which drug is most commonly used?

-Ergots
-Dihydroergotamine

12

What is a common scenario in which we use Ergots?

May work for patients who have not previously responded to triptans

13

Dihydroergotamine is associated with what ADR's?

N/V/D common

14

What are the 'triptan' drugs?

Sumatriptan ***
Zolmitriptan ***
Rizatriptan
Almotriptan
Eletriptan
Naratriptan
Frovatriptan ***

15

What is the end result of triptans agonizing serotonin receptors

Vasoconstriction of cranial arteries

16

What is a pearl about the use of Frovatriptan?

-Takes 2 hours to work and then has a 25 hour half life
-Good for patients with slow onset of symptoms

17

What is the clinical indication for the -triptans? What route is most effective?

-Moderate to severe acute migraine with or without aura
-SQ route is most effective (especially when patients have N/V)

18

What is a special indication for a sumatriptan injection?

Cluster headaches

19

In what patients are the triptans generally avoided in?

-Ischemic CVA/HD
-Ischemic CAD/PAD
-Ischemic bowel
-Uncontrolled HTN
-Raynaud's
-Pregnancy

20

If triptans are an option for someone with cardiac RF, what must you do?

Cardiac eval before use

21

Triptan metabolism

-Sumatriptan and zolmitriptan are metabolized by MAO enzymes
-Avoid MAOI

22

Which drugs cannot be administered within 24 hours of triptans

Ergots due to enhanced vasoconstricting effects

23

What drug (which is commonly used for migraine prophylaxis) increases the concentration of triptans?

Propranolol

24

What are the ADRs associated with the three forms of sumatriptan?

-PO --> well tolerated with mild nausea

-SQ --> Burning sensation

-Intranasal --> Unpleasant aftertaste

25

What is the proposed mechanism of 'gepants'

-small molecule CGRP antagonists to decrease pain signaling

26

What are the two 'gepant' drugs?

Rimegepant
Ubrogepant

27

What is the one "ditan" drug presented to us

Lasmiditan

28

What is a pearl about -gepants and -ditans?

Less effective than triptans but can be used in patients with vascular disease

29

What are the devices approved for acute treatment of migraines?

-Transcranial magnetic stimulation device

-Remote electrical neuromodulation device (band on arm)

-Transcutaneous electrical nerve stimulation (cyclops)

-Vagus nerve stimulation device