Migraine/HA

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Author:
alvo2234
ID:
214214
Filename:
Migraine/HA
Updated:
2013-04-18 09:39:13
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Ndefo
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Description:
PT I exam III
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  1. how long does migraines develop
    minutes to hours
  2. which type of headache gives dull ache and pulsating pain
    migraine
  3. what part of the brain do migraines begin
    front temporal region and may radiate to neck
  4. how long can migraines last
    several hours to 3 days
  5. common migraine
    migraine without aura
  6. how to diagnose migraine
    • must have at least 5 attacks lasting 4-72 hrs with at least two of the following criteria:
    • unilateral location
    • pulsating
    • mod or severe intensity
    • aggravation by routine physical activity
    • must have N and or V
  7. classic migraine
    migraine with aura
  8. at least two attacks with at least 3 of the following
    • one or more fully reversible aura symptoms
    • at least one aura symptom (> 4 min)
    • two or more Sx occurring in succession
    • no single aura Sx lasting > 60 minutes
    • HA follows aura within 60 minutes
  9. when do menstrual migraines occur
    • days 1 or 2 of cycle
    • ovulation
    • right after cycle
  10. how long do cluster HA last
    less than 3 hrs
  11. which HA is always unilateral
    cluster
  12. which HA has excruciating sensation of burning or throbbing behind the eye
    cluster
  13. what may you experience from cluster HA
    unilateral lacrimation, rhinorrhea, flushing
  14. how to diagnose cluster HA
    • must have several episodes or clusters
    • short lived but severe
    • unilateral
    • at least one of the following Sx
    • conjunctival injection
    • lactrimation
    • nasal congestion
    • rhinorhea
    • facial sweating
    • miosis (excessive response to light)
  15. description of tension HA
    dull, persistent HA that is bilateral in hat band distribution around the head
  16. how to diagnose tension HA
    • at least 10 previous HA
    • each lasting 30 min to 7 days
    • two of the following Sx:
    • pressing/tightening
    • intensity mild to moderate
    • bilateral location
    • no aggravation with physical activity
  17. non pharmacological options
    • avoid aggravating factors
    • behavioral therapy
    • acupuncture
    • heat and cold
    • impulse magnetic field therapy
    • aerobic exercises
    • chiropractic manipulations
  18. drug of choice for migraine and cluster HA
    triptans
  19. which triptans are available as ODT formulations
    zolmitriptan and rizatriptan
  20. some notable side effects of triptans
    • coldness
    • decreased distal pulse
    • tingling sensation
    • rebound HA
  21. triptans are contraindicated in
    • CAD
    • stroke
    • uncontrolled HTN
    • PVD
    • ischemic bowel disease
    • pregnancy
    • 2 weeks of MAOI
    • 24 hrs of ergotamines
  22. use triptans with caution with
    other serotonin active meds
  23. what is the drug in the triptan class
    sumatriptan
  24. how long is sumatriptan effective after onset of migraine
    4 hours
  25. side effects of sumatriptan
    • malaise, dizziness
    • intranasal bitter taste
    • SQ injection site irritation
    • chest pressure/tightness
    • MI
    • stroke
    • rebound HA
  26. which triptans have less ADEs
    naratriptan and almotriptan
  27. naratriptan onset time
    1-3 hours
  28. almotriptan onset time
    0.5 - 2 hrs
  29. frovatriptan onset time
    2 - 3 hrs
  30. sumitriptan onset time (oral)
    20-30 min
  31. imitrex nasal spray onset time
    1-1.5 h
  32. imitrex SQ onset time
    10 - 15 min
  33. sumatriptan patch brand name
    zecuity
  34. sumatriptan/naproxen brand name
    treximet
  35. sumavel, DosePro onset
    10 minutes
  36. rizatriptan brand and onset
    maxalt (PO) .5 - 2 hrs
  37. eletriptan brand and onset
    relpax (PO) 30 min
  38. Zomig generic and onset
    zolmitriptan 45 min
  39. zomig nasal spray onset
    15 min
  40. DHE formulations
    • PO
    • IV
    • SQ
    • intranasal
  41. ergotamine available formulations
    • PO
    • PR
  42. when should ergot alkaloids be administered
    • at the first sign of migraines
    • rarely effective in established migraine
  43. common side effects of ergot alkaloids
    NV and anorexia
  44. ergot alkaloids are contraindicated in pts with
    • CAD
    • stroke¬†
    • uncontrolled HTN
    • PVD
    • ischemic bowel disease
    • pregnancy
  45. frequency of barbiturate administration
    may take up 1-2 tablets QID, 2 days a week
  46. fiorinal
    butalbital/ASA/caffeine
  47. fioricet
    butalbital/APAP/caffeine
  48. NSAIDs are used for which severity of HA
    mild to mod
  49. how and when can butorphanol be administered
    intranasally for pts with nausea/vomiting
  50. how are corticosteroids used in abortive therapy for migraines
    as rescue therapy for status migrainous or intractable migraine
  51. Midrin generic name
    isometheptene/dichlorphenezine/APAP
  52. antiemetic use in abortive migraine therapy
    • effective for NV associated migraines
    • increase GI absorption
    • may have antimigrainous properties
  53. metoclopramide brand/dosing
    reglan 10mg
  54. prochlorperazine brand/dose
    compazine 10mg
  55. how is caffeine used
    as an adjunct
  56. caffeine can aggravate
    • heart conditions
    • depression
    • anxiety
    • peptic ulcers
  57. how often should migraine prophylaxis be taken
    daily
  58. how long should they be tried for
    2-3 months
  59. 1st line prophylaxis therapy
    valproic acid, topiramate, propranolol, timolol, amitriptyline
  60. valproic acid/divalproex brand and dosing
    • depakote
    • 250 mg BID; increase by 250 mg NTE 2000 mg/day
  61. topiramate brand/dosing
    • topamax
    • start at 25 mg/day and titrate to 100mg/day in 2 div doses
  62. propranolol dosing
    20 mg BID-TID; titrate to 320 mg/day
  63. timolol brand/dosing
    • blockadren 10 mg BID
    • up to 30 mg daily
  64. amitriptyline brand/dosing
    • Elavil 10-25 mg q hs
    • titrate up to max dose of 150 mg/day
  65. amitriptyline can be used for which type of HA prophylaxis
    migraine and tension
  66. what antidepressants can be used for migraine prophylaxis
    • amitriptyline
    • nortriptyline
    • phenelzine
    • fluoxetine
  67. treatment for cluster HA
    • triptans 6mg SQ
    • oxygen 6-7 L/min
    • intranasal lidocaine 20 - 60 mg nasal/spray
    • ergotamine SQ or PR
    • DHE IV SC IM
  68. prophylactic agents used to treat cluster HA
    • verapamil
    • ergotamine
    • corticosteroids: prednisone and decadron
    • lithium
    • topiramate
    • indocin
  69. acute treatments for tension HA
    • acetaminophen 1000 mg
    • aspirin 650 mg
    • ibuprofen 400 - 800 mg
    • naproxen 550 mg
  70. ibuprofen has less side effects than
    ASA
  71. Naproxen 550 is more effective than
    APAP 650
  72. prophylactic agents for tension HA
    • amitriptyline
    • botulinum toxin
  73. DOC for tension HA prophylaxis
    elavil
  74. when may pts develop analgesic rebound HA
    pts who use analgesics more than 3 times a week
  75. how to treat analgesic rebound HA
    withdraw all analgesics but not prophylactic meds

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