neuro/psych-quiz 2-headache

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Ambestul
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neuro/psych-quiz 2-headache
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2010-03-01 15:47:04
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headache
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quiz 2
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  1. MOH
    medication overuse headache, ≥5-10 days/month opioid or combo analgesics, triptans can contribute to MOH if high freq of migraine at baseline: more than 10/mo, antiinflammatories may be protective is less than 10 at baseline, ≥15 days/mo of simple analgesics
  2. migraine with aura
    visual and/or sensory, 5-20 minutes and lasts less than or equal to 60 minutes, 18% of migraines
  3. migraine without aura
    can have prodome, same length and aura sx-irritability, depre, difficulty concentrating, photophobia, and phonophobia
  4. tension HA
    not aggravated by activity, bilateral, pressing, non-pulsating, hatband HA, mild-mod, can also have muscle tenderness or knots, can be infreq or nearly daily
  5. cluster HA
    daily for weeks to months, severe pain, lasts 20-2 hours, unilateral orbital and/or temporal, often w ipsilateral rhinorrhea, lacrimation, eyelid edema, blurred vision, forehead or facial sweating and feeling of restlessness or agitation, NSAIDs not effective
  6. no OTC recommendation for HA
    rapidly increasing HA freq, hx of lack of coordination, hx or localized neurologic signs or sx, hx of HA causing awakeing from sleep
  7. pathogenesis of migrain
    depressed electrical activity(consistent with spread of aura sx), decreased blood flow, imbalance of serotonergic and noradrenergic neuronal activity?, vasodilation, activation of trigeminal nerve, release of neuropeptides and calcitonin-gene-related peptides, neurogeni inflamm of dural blood vessels, transmission of nociceptive info from trigem to thalamus and cortex where pain is perceived
  8. 5HT-1B
    constriction of some vascular smooth muscle and vasoconstr-agonists useful in acute migraine tx
  9. 5HT-1D
    inhibits neurogenic inflammatory response presynaptically, inhibits n&v w migraine
  10. 5HT-2
    causes vasoconstriction, platelet aggregation, useful in prophylactic migraine tx and can prevent initial vasodilation that leads to migraine
  11. acute tx of episodic tension HA
    should not be more than 2-3 days/wk to prevent MOH, ASA, NSAIDs, APAP, NSAIDs probably more effective +- caffeine, analgesics with sedation(butalbital or codeine) high potential for overuse and dependency, use only in refractory cases
  12. Preventative tx of chronic tension HA
    if: >2 HA/wk, duration >3-4 hours, severity results in medication overuse or substantial disability, ami 75-150mg/d, tizanidine(limited efficacy), botulinum toxin inj(conflicting studies)
  13. Acute (abortive) tx of migraine
    limit to 2 days/wk, use as early as possible, triptans, selective for 5_HT-1B/1D agonists
  14. triptan SE
    parasthesias, dizziness, warm sensations, somnolence, chest pressure, tightness (15), CONTRA MI and angina, may repeat X1 after 2 hours
  15. Imitrex
    sumatriptan
  16. zolmitriptan
    zomig, 2.5 mg and 5 mg, eletriptan 40 mg, and rizatriptan 5 mg all showed similar results
  17. naratriptan
    amerge, 2.5 mg and eletriptan 20 mg showed lower efficacy and better tolerability
  18. rizatriptan
    maxalt, 10 mg showed better efficacy and consistency and similar tolerability
  19. almotriptan
    axert, 12.5 mg showed similar efficacy at 2 hours but better other results, may be helpful for pts who are especially sens to feelings of chest pressure and other side effects
  20. frovatriptan
    frova, longest half-life
  21. eletriptan
    relpax, 80 mg showed better efficacy, similar consistency, but lower tolerability, may work if not responding to others
  22. INX with triptans
    ergot-separate at least 24 hours from triptan, SNRI and SSRI-serotonin syn
  23. metoclopramide
    may facilitate abs of the acute drug and decrease vomiting
  24. isometheptene
    sympathomimetic amine, in midrin with APAP and dichloralphenazone
  25. dichloralphenazone
    chloral hydrate derivative
  26. APAP
    not approved on its own for migraine but is contained in OTC prep with ASA and caffeine
  27. ketorolac
    IM only in supervised settings
  28. ergotamine tartrate and dihydroergotamine (DHE)
    nonsel 5-HT-1 agonists=potent vasocontrictors, N&V, ergotism sx of peripheral ischemia, rebound HA with ergotamine, CONTRA-CVD, preg, ergot and triptans not within 24 hours
  29. max ergotamine dose
    6mg/d; 10mg/wk
  30. preventative tx of migraines
    consider if disabling, acute tx >2 days/wk, cannot tolerate abortive tx, tx not effective, 2 to 3 month trial, continue 3-6 months, so up to 6-9 months
  31. beta blockers for migraine prevention
    propranolol(A), timolol(A), atenolol, meto, nado(B)
  32. amitriptyline, migraine
    50-100
  33. anticonvulsants-migraine
    valproate (A), topiramate(C-but will probably change, most common), gabapentin(B)
  34. calcium channel blocker-migraine
    verap(B), 2nd or 3rd line
  35. methysergide-migraine
    (A) blocks dev of neurogenic inflam via stabilization of 5-HT neurotransmission, drug holiday one month out of 6 due to fibrosis, SE-claudication, GI upset, wt gain, muscle ache, refractory
  36. abortive tx for cluster HA
    oxygen, 6-7 L/min for 10-15 min, ergotamine (IV or IM), 3-7 d of admin can break cycle of freq attacks, triptans(nasal or SQ)
  37. preventative tx for cluster HAs
    short-term:CSs, 7-10 d then taper 5-10mg/d, rapid onset but high recurrence rate, methysergide, ergotamine, long-term preventative: verap(DOC) effective after 1 week and 70%, lithium, gabe, topi, valpro, melatonin

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