Headache cases - Lecture 8 - Dr. Klucken

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VASUpharm14
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Headache cases - Lecture 8 - Dr. Klucken
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2013-04-08 18:14:15
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h/a  Understand the primary HA disorders and be able to rule out serious secondary problems  Describe the presentation of the primary HA disorders  Be able to recommend appropriate treatment for primary HA disorders o Non-pharmacologic therapy o Abortive and preventative pharmacotherapy
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  1. 3 primary h/a disorders
    • 1. migraine
    • 2. tension
    • 3. cluster
  2. migraines epidemiology (6)
    age, gender, severity, comorbidities, frequency, timing
  3. 6 etiology of migraines
    • 1. vascular hypothesis
    • 2. neuronal dysfunction (aura, pain, associated sx)
    • 3. neurovascular migraines
    • 4. brainstem
    • 5. genetics
    • 6. mediators
  4. migraines definition
    • common, recurrent, severe H/A
    • interferes with normal functioning
  5. secondary H/A disorders
    • CNS infections like meningitis, head
    • trauma, tumors/stroke/hemorrhaging
  6. presentation of migraines
    premonitary sx --> aura --> h/a --> resolution
  7. 2 types of migraines
    • with aura
    • without aura
  8. symptoms of migraines (5)
    • 1. throbbing/pulsating (4-72 hours - untreated)
    • 2. unilateral (usually)
    • 3. frontotemporal region
    • 4. associated with N/V, photo/phonophobia w/o aura
    • 5. worsens with physical activity
  9. signs of migraines (4)
    • 1. +family history
    • 2. food triggers
    • 3. menstrual association
    • 4. improvement with sleep
  10. alarm symptoms - rule out
    • acute onset
    • first h/a ever
    • worst h/a ever - stroke!!
    • onset after age 50
    • associated with systemic illness - infection
    • h/a with focal neurologic symptoms or papilledema - stroke
    • new onset h/a in patient with cancer/HIV
  11. nonpharm for migraines
    diary, avoid triggers
  12. frequent attacks >2-3 days of the week
    prophylactic NOT abortive therapy
  13. treatment migraines: infrequent mild-moderate
    analgesics
  14. treatment migraines: moderate - severe
    first line: triptans, ergotamines, dihydroergotamines, opioids

    GI issues: can't use oral
  15. FDA approved migraine prophylaxis (4)
    • propranolol
    • timolol
    • valproate
    • topiramate
  16. migraine prophylaxis (5)
    • 1. NSAIDs - ASA, IBU, naproxen, APAP/ASA/CAF (Exedrin)
    • 2. BB - metoprolol, atenolol, nadolol
    • 3. CCB - verapamil
    • 4. Antidepressants - TCAs (Amitriptyline), SSRIs/SNRIs
    • 5. Anticonvulsants - divalproex, gabepentin
  17. Most common type of primary h/a
    tension
  18. presentation of tension h/a
    • NO premonitory symptoms of aura
    • mild-moderate - dull, NONPULSATILE tightness or pressure
    • BILATERAL
    • frontal, temporal pain
    • NOT worsened with physical activity
  19. nonpharm tx for tension h/a
    stress management
  20. Rx therapy for tension h/a
    • simple analgesics
    • -monotherapy
    • + caffeine
  21. most serious type of primary h/a
    cluster h/a
  22. presentation of cluster h/a
    • MEN > women
    • NO premonitory symptoms or aura
    • severe - excruciating, penetrating, boring
    • UNILATERAL
    • orbital, supraorbital, temporal
    • occurs in series
    • occurs at night (spring/fall) - lacrimation, congestion, facial swelling
  23. abortive tx for cluster h/a
    • oxygen 100% x 15-30 mins - delays attack only
    • ergotamine derivatives - combo with Li/verapamil
    • triptans
  24. prophylactic tx for cluster h/a
    • verapamil
    • lithium - combo w/verapamil (monitor thyroid
    • and renal function - NSAIDs)
    • ergotamine - combo w/Li & verapamil
    • corticosteroids - induce remission (3 wks)
  25. H/A diary (5) to log
    • 1. frequency - need for prophylaxis
    • 2. severity
    • 3. duration
    • 4. med use - response, assess for adequate/overuse
    • 5. potential triggers

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