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What are the characteristics of a tension HA?
- constant tight pressure
- "hatband" distribution
- NO throbbing
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?
- anxiety disorder
What neurotransmitters are involved in migraine?
- calcitonin gene-receptor peptide
How long do migraines last?
What is a migraine hangover?
- scalp tenderness
- may last 1-2d
What are the non-pharmacologic tx for migraine?
- quiet, dark rooms
- ice packs
- avoidance of triggers
- regular sleep
- eating habits
- behavioral intervention
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)
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?
- ergot alkaloids
- magnesium sulfate
- 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?
- tingling sensations
- 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?
- uncontrolled HTN
- hx of stroke or TIA
Which ergot alkaloid comes in an injectable form?
dihydroergotamine mesylate (DHE)
What are the SE of ergot alkaloids?
- leg cramps
- 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?
- refractory pts
- 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
- narcotic analgesics
- IV phenothiazines
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)
- CCB (verapamil)
Which NSAID is the best for menstrual migraine prophylaxis?
What are the first line drugs for migraine prophylaxis?
- divalproex sodium
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?
- 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
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?
- propranolol DOC
- divalproex sodium
What is the acute treatment for tension headache?
- simple combinations
- 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 NO EFFICACY
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
What are the acute treatments for cluster HA?
What are the preventative treatments for cluster HA?
What would you like to do?
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