Headache

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Author:
giddyupp
ID:
40688
Filename:
Headache
Updated:
2011-01-13 13:08:30
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Headache PHPR521
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Description:
Headache
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  1. What are the characteristics of a tension HA?
    • constant tight pressure
    • "hatband" distribution
    • NO throbbing
  2. What are the characteristics of a tumor HA?
    • steady, aching pain
    • may have acute onset
  3. What are the characteristics of a subarachnoid hemorrhage HA?
    • sudden, severe pain
    • "worst headache of my life"
  4. Which gender is more likely to have at least 1 migraine per year?
    women
  5. Before age 12, which gender has more migraines?
    boys
  6. What comorbidities are sometimes associated with migraine?
    • stroke
    • IBS
    • HTN
    • depression
    • anxiety disorder
    • epilepsy
  7. What neurotransmitters are involved in migraine?
    • 5-HT
    • DA
    • GABA
    • NMDA
    • calcitonin gene-receptor peptide
  8. How long do migraines last?
    4-72h
  9. What is a migraine hangover?
    • fatigue
    • irritability
    • weakness
    • euphoria
    • scalp tenderness
    • anorexia
    • may last 1-2d
  10. What are the non-pharmacologic tx for migraine?
    • quiet, dark rooms
    • ice packs
    • avoidance of triggers
    • regular sleep
    • exercise
    • eating habits
    • behavioral intervention
  11. 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
  12. 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
  13. When may abortive tx alone be appropriate?
    • pt experiences <2 attacks/mo
    • pt has CI to preventive tx
  14. 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
  15. Which drugs are the DOC for abortive tx of migraine?
    serotonin receptor agonists (triptans)
  16. How long does it usually take for a triptan to be effective?
    2hrs
  17. 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
  18. What are the CI of the triptans?
    • CAD
    • uncontrolled HTN
    • arrhythmias
    • PVD
    • hx of stroke or TIA
    • pregnancy
  19. Which ergot alkaloid comes in an injectable form?
    dihydroergotamine mesylate (DHE)
  20. 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)
  21. What are the CI of ergot alkaloids?
    • pregnancy
    • nursing
    • caution in HTN
  22. What is the role of VPA in abortive tx in migraine?
    • refractory pts
    • CI to triptans or ergots
  23. Why are phenothiazines and butyrophenones used in abortive tx of migraine?
    • sedative and antiemetic properties
    • for pts who cannot tolerate triptans or ergots
  24. What is status migrainosus?
    • HA lasting > 72hrs despite tx
    • includes severe head, neck, or face pain; GI sx, insomnia
    • often requires hospitalization
  25. What is the tx for status migrainosus?
    • DHE or triptans
    • narcotic analgesics
    • IV phenothiazines
  26. 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
  27. How long should you use a drug for migraine before changing it to something else?
    2-3 months minimum
  28. When should you think about discontinuing migraine medication?
    if controlled for 3-6 months

    taper the drug
  29. What are the agents for prophylactic tx for migraines?
    • beta blockers DOC
    • TCAs (AD DOC for migraine)
    • anticonvulsants
    • CCB (verapamil)
    • ACE/ARB
    • NSAIDS
  30. Which NSAID is the best for menstrual migraine prophylaxis?
    naprosyn
  31. What are the first line drugs for migraine prophylaxis?
    • amitriptyline
    • divalproex sodium
    • propranolol
    • timolol
  32. 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
  33. 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
  34. What drugs should be used in kids with acute migraine?
    • ibuprofen
    • apap
    • sumatriptan nasal spray
    • oral triptans (no data)
  35. What drugs should be used in kids for migraine prophylaxis?
    • propranolol DOC
    • flunarazine
    • cyproheptadine
    • amitriptyline
    • divalproex sodium
    • topiramate
    • levetiracetam
  36. 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
  37. What is the preventative treatment for tension headache?
    • amitriptyline (+/- tizanidine)
    • mirtazapine

    • SSRI and botulism have NO EFFICACY
  38. 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
  39. What are the acute treatments for cluster HA?
    • sumatriptan
    • zolmitriptan
    • lidocaine
  40. What are the preventative treatments for cluster HA?
    • verapamil
    • Li
    • corticosteroids
    • topiramate

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