question

Acute treatment of migraines: 1. (_) 2. Migraine specific abortive treatment- (_) 3. (_) Alkaloids and derivatives 4. (_) combinations

answer

Analgesics/NSAIDs Triptans Ergot Opioid

question

Not used unless SEVERE- have lots of SE

answer

Opioids

question

Prophylaxis for migraines? When is prophylaxis recommeneded?

answer

BB CCBs TCAs Anticonvulsants Ergot alkaloids with more than 1 migraine per week

question

Headache in which muscle contraction is a significant factor in the pain process

answer

Tension headache

question

Stress management & relaxation techniques can help decrease the severity & frequency of (_) headache

answer

tension

question

Treatment for tension headaches?

answer

OTC analgesics and NSAIDs Rx strength NSAIDs Rx analgesic combinations

question

Trigger Point injections are a potential treatment for (_)

answer

Tension ha

question

Pain is thought to involve activation of trigeminal neurons with release of vasoactive peptides- Autonomic dysfunction with sympathetic under-activity & parasympathetic over-activity

answer

Cluster ha

question

4 Abortive Treatment for Cluster headaches?

answer

Oxygen Ergotamine/DHE Triptans Corticosteroids

question

inhalation of 100% oxygen x 10-15 min- relieves pain almost immediately in 70% patients via vasocontriction

answer

Oxygen- cluster ha

question

Ergotamines can be given IV or (_) and repeated administration of (_) x3-7 days can break the cycle of (_) headaches

answer

IM DHE cluster

question

Sumaptriptan (Imitrex®): SC provides relief in 15 minutes

answer

Triptan for Cluster headache

question

Medium to high dose x several days then taper over 1 wee;- Dexamethasone

answer

Cluster headache

question

CCB such as (_) (_) and (_) are all used for prophylaxis of cluster headaches?

answer

Verapamil Lithium Ergotamine

question

Caution: renal disease, cardiovascular disease, pregnancy

answer

Lithium

question

Dosed QHS to prevent noctural headache attacks

answer

Ergotamine

question

Many patients with (_) also experience daily headaches that are often worse upon arising. How do we treat these kind?

answer

depression Antidepressants- SSRIs and TCAs

question

What is the first line treatment for Trigeminal neuralgia? What is a side effect?

answer

Carbamazepine and Gabapentin Feel a bit sedated with Gabapentin

question

What is the second line treatment for Trigeminal Neuralgia?

answer

Phenytoin Valproic Acid

question

Sinus headaches are typically due to (_) and must be treated with (_) for potential bacteria, (_) for inflammation and (_) for congestion?

answer

Abx NSAIDs/Corticosteroids Decongestants

question

Nasal steroid sprays- Fluticasone

answer

Used for inflammation in sinus headaches

question

Pseudoephedrine and Oxymetazoline

answer

Decongestants and vasoconstrictors for congestion associated with treatment of congestion and sinus headaches

question

Medical and/or dental conditions affecting the TMJ or muscles of mastication- Headache, ear/jaw pain, stiffness

answer

TMJ disorders

question

Treatment of TMJ disorders?

answer

NSAIDs Relaxation techniques Muscle relaxants Dental appliances

question

What muscle relaxants can we use for TMJ disorders?

answer

Flexeril and Robaxin

question

(_)s are effective treatment for mild to moderate headaches

answer

NSAID

question

Mechanism of action of NSAIDs: Inhibit/prevent inflammation in (_) system by inhibition of (_)

answer

trigeminovascular PGs

question

SE of (_): GI upset, dizziness, headache, rash, tinnitus, edema, bleeding tendency, acute renal failure

answer

NSAIDs

question

(_) action NSAIDs are preferred over (_) acting and (_) release. Examples?

answer

rapid long slow Ibuprofen (Advil, Motrin) and Diclofenac (Voltaren)

question

This medication is for severe headache with N/V. Suppositories and injections are available. Comes in IV form so good for IM injection in clinic when patient is vomiting.

answer

Toradol

question

Most OTC NSAIDs are (_) inhibitors- they will block the production of (_) in order to reduce the amount of inflammatory markers in that way

answer

COX PGs

question

Specific, always present

answer

COX1

question

Nonspecific, will be released in site of inflammatory process?

answer

COX2

question

Caution GI Upset and Bleed

answer

NSAIDs

question

(_) are effective for mild to moderate headaches

answer

Analgesics

question

Acetaminophen such as (_) are (_)

answer

Tylenol and ASA and Excedrin Analgesics

question

Butalbital is a (_) with probably mechanism of action including (_) and (_) relaxation

answer

barbituate sedation muscle

question

Indication: specifically indicated for tension type headache, also provides some relief with other types of headache

answer

Butalbital

question

AE include rebound headache and tolerance with frequent or continued use?

answer

Butalbital

question

1. Butalbital + Acetaminophen 2. Butalbital + Acetaminophen + Caffeine 3. Butalbital + Aspirin + Caffeine

answer

Cephadyn Fioricet Fiorinal

question

i. Fioricet with Codeine® ii. Fiorinal with Codeine® The above options are (_) and are NOT the first line therapy for headaches

answer

Opioid

question

Synthetic opioid agonist-antagonist

answer

Butorphanol Nasal SPray

question

ii. 1 mg (1 spray in one nostril) If adequate pain relief is not achieved within 60-90 minutes, an additional 1-mg dose may be given. iii. May be repeated in 4 hours

answer

Butorphanol Nasal Spray

question

Common opioid AE?

answer

Drowsiness, Dizziness, CNS depression, local effects such as nasal mucosa irritation

question

(_) is approved for tension & vascular headache

answer

Midrin ]

question

1st line for moderate to severe migraines or for rescue therapy when nonspecific medications are ineffective

answer

Triptans

question

Serotonin receptor agonists (5HT). Most are limited to (_) doses in (_) hours and not more than a couple of times per week

answer

Triptans 2 24

question

5HT1(_):Vasoconstriction of intracranial blood vessels

answer

B

question

5HTI(_) : inhibition of vasoactive neuropeptides, interruption of pain signal transmission

answer

D

question

AE of (_): Paresthesias, fatigue, dizziness, flushing, warm sensation, somnolence, chest tightness, pain in neck/jaw Isolated cases of MI & coronary vasospasm with ischemia

answer

Triptans

question

Contraindications for Triptans: 1. (_) heart disease, (_) HTN, CVD, (_)plegic and (_) migraine

answer

Ishemic uncontrolled Hemi Basilar

question

DO NOT GIVE THESE within 24 hours of ergotamines?

answer

Triptans

question

Avoid within 2 weeks of MAOIs

answer

Triptans

question

Avoid use during pregnancy?

answer

Triptans

question

Sumatriptran can be given in what three ways? which works quickest? May have recurrence of HA with this drug and require 2nd dose within 24 hours

answer

PO - 30 mins SC- 10 mins** Intranasal- 15 mins

question

2nd generation triptans generally have (_)

answer

longer half lives

question

Treatment of moderate to severe migraine headache, cluster headache

answer

Ergot Alkaloids and Derivatives

question

Non-selective 5HT1 receptor agonists Constrict intracranial blood vessels & inhibit neurogenic inflammation in the trigeminovascular system Also have activity at alpha & beta adrenergic, & dopaminergic receptors

answer

Ergot Alkaloids and Derivatives

question

AKA severe peripheral ischemia: cold, numb painful extremities

answer

ergotism associated with the use of Ergot alkaloids and derivatives

question

Can get N/V with these meds and may want to consider an antiemetic prior to administration.

answer

Ergot Alkaloids and Derivatives

question

(_) is CI in: i. Renal failure, hepatic failure ii. Coronary, cerebral, or peripheral vascular disease iii. Uncontrolled Hypertension iv. Sepsis v. Pregnancy/Nursing

answer

Ergot Alkaloids and Derivatives

question

This med can be given PO, SL, or PR (per rectum). PO and PR formulations contain (_)to enhance absorption & potentiate analgesia

answer

Ergotamine Tartrate Caffeine

question

With Ergotamine Tartrate, PO undergoes (_) so, PR may be (_). It is much more emetogenic than (_)

answer

1st pass metabolism preferred DHE

question

This ergot alkaloid/derivative can be given intranasally, parenteral or SQ?

answer

DHE

question

Ergotamine + Caffeine

answer

Cafergot

question

semisynthetic ergot alkaloid, 5HT2 antagonist that is used for REFRACTOY HAs due to SE?

answer

Methsergide

question

4 week medication-free interval is suggested for every 6 months of continuous use (taper over 1 week to prevent rebound HAs)

answer

Methsergide

question

Retroperitoneal, endocardial & pulmonary fibrotic complications have occurred with long-term use

answer

Methsergide

question

This med requires monitoring for fibrotic conditions: chest auscultation, CXR, ECHO

answer

Methsergide

question

Use for (_) include: i. Intractable migraines ii. Reserve for severe, infrequent use in patients who have contraindications for conventional therapies iii. Rescue medications when failure to conventional therapies occurs iv. Avoid chronic use do to re-bound headaches

answer

Opioids

question

The following are in what class? Codeine, Meperidine, Butorphanol

answer

Opioids

question

1. Available for injection in office or nasal spray for patient use 2. Onset within 15 minutes 3. SE: dizziness, N/V, drowsiness, TASTE disturbances 4. Controlled medication

answer

Butorphanol

question

NV associated with migraines can be treatd with what?

answer

Phenergan Prochlorperazine Benadryl

question

This is a combo therapy that has a beneficial effect when taken together to prevent central sensitization in migraine cascade? Examples?

answer

Triptan and NSAIDs Treximet

question

This combo therapy focuses on delayed gastric emptying that contributes to N./V. It may also increase the onset of Triptan?

answer

Triptan + Metoclopramide/ REglan

question

Preventative therapy can be used when MHA occur in a predictable (_)(menstrual migraines)

answer

pattern

question

-Response varies greatly: usually tried for 2-3 months -Initiated at low doses and advanced until therapeutic effects or intolerable SE, usually continued for 3-6 months then reassessed

answer

Migraine prophylaxis therapy

question

Medication used in the prophylaxis of migraines- .use these due to lipophilicity and can cross the BBB

answer

Beta Blockers ****Propanolol Metoprolol Atenolol

question

Medication used in the prophylaxis of MHA that is dosed in the evening due to drowsiness. Examples?

answer

TCAs Amitriptyline Doxepin, Nortriptyline

question

Can anticonvulsants and CCBs be used for migraine prophylaxis?

answer

Carbamazepine Valproic Acid Topiramate Verapamil

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