Card Set Information
What are the characteristics of a tension HA?
constant tight pressure
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?
Before age 12, which gender has more migraines?
What comorbidities are sometimes associated with migraine?
What neurotransmitters are involved in migraine?
calcitonin gene-receptor peptide
How long do migraines last?
What is a migraine hangover?
may last 1-2d
What are the non-pharmacologic tx for migraine?
quiet, dark rooms
avoidance of triggers
You need at least 2 of what symptoms to diagnose migraine?
moderate or severe intensity
aggravation by (or avoidance of) routine phys activity
during the headache:
n/v (or both)
What should be considered when choosing abortive tx of migraine?
associated sx - N,V
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?
skeletal muscle relaxants
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?
What are the SE of triptans?
burning or warm sensations
transient increased BP
pain, pressure, tightness or heaviness of chest, neck, and/or jaw (SQ sumatriptan the most)
What are the CI of the triptans?
hx of stroke or TIA
Which ergot alkaloid comes in an injectable form?
dihydroergotamine mesylate (DHE)
What are the SE of ergot alkaloids?
numbness in the exptremities
ergotism (severe vasoconstrictive crisis)
rhinitis, congestion, taste disturbances (intranasal DHE)
What are the CI of ergot alkaloids?
caution in HTN
What is the role of VPA in abortive tx in migraine?
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
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)
Which NSAID is the best for menstrual migraine prophylaxis?
What are the first line drugs for migraine prophylaxis?
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?
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?
sumatriptan nasal spray
oral triptans (no data)
What drugs should be used in kids for migraine prophylaxis?
What is the acute treatment for tension headache?
NSAID > APAP
limit to 2-3 d/week or can get analgesic rebound headaches
What is the preventative treatment for tension headache?
amitriptyline (+/- tizanidine)
SSRI and botulism have
What are the features of cluster headaches?
intense piercing-throbbing pain
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?
What are the preventative treatments for cluster HA?