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Chapter15
Headache In Adults
37
Medical
Professional
09/28/2011

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Term
FIGURE 1 pg 200... types of Headaches
Definition
FIGURE 1 pg 200... types of Headaches
Term
Analgesics for mild to moderate HA?

To avoid analgesic induced HA, how long should these be used for ?
Definition
ASA, Ibuprofen, APAP, Butalbital, Naproxen

Do not use for more than 15 days per month to avoid analgesic induced HA
Term
How long should opioid and combination analgesics be used for ?
Definition
No more than 10 days per month
Term
Role of Ergotamine in HA ?

What limits its use? Name them

Contraindications
Definition
Ergotamine is used for cluster HA or migraines...

Side effects including Chest pain, tingling, nausea, vomiting, paresthesias, & ergot dependence limit its use

Contraindications: Pregnancy, cardiac disorders, HTN, sepsis, potent inhibitors of 3A4
Term
Dihydroergotamine mesylate (DHE)

Uses ?

Dependence ?

Side effects?

Contraindications?
Definition
Dihydroergotamine mesylate (DHE)

Uses - Can be used for acute intractable headache or withdrawal from analgesics

Dependence - NO, whereas ergotamine DOES

Side effects & Contraindications - SAME as ergotamine: Side effects including Chest pain, tingling, nausea, vomiting, paresthesias

Contraindications: Pregnancy, cardiac disorders, HTN, sepsis, potent inhibitors of 3A4
Term
Sumatriptan SQ place in therapy
Definition
SQ Sumatriptan - Fastest onset of action and most efficacious for SEVERE migraine. Also efficacious in cluster HA.
Term
Naratriptan Place in therapy
Definition
Slowest onset of action (max efficacy at 4 hours).

*SE's near placebo

Naratriptan good for MODERATELY SEVERE migraine attacks, or for individuals with low tolerance to triptan SE's
Term
Limit on use per month in triptans?
Definition
10 days !
Term
Contraindications of triptans?
Definition
Cardiac disorders, hypertension, basilar (back portion of the head, causes aura, vertigo, tinnitus) and hemiplegic (paralysis on one side of the body) migraine
Term
Triptan SEs
Definition
Chest discomfort, dizziness, paresthesias, fatigue
Term
What kind of HA disorders are corticosteroids useful in?
Definition
Corticosteroids are useful in status migrainosus, cluster HA, cerebral neoplasms with edema, temporal arteritis
Term
Treatment Resistant HA, what agent should be used?

Last resort agent?
Definition
Treatment Resistant HA, what agent should be used - Ketorolac

Last resort agent - Meperidine IV or IM
Term
In what kind of HA is indomethacin useful
Definition
Chronic Paroxysmal hemicrania
Term
What antinauseant agent is useful as an adjunctive therapy in HA ?

What antiemetic/prokinetic agents are useful?
Definition
Anti-nauseant: Dimenhydrinate

Antiemetic/prokinetic: Metoclopramide or Domperidone
Term
When is prophylaxis vs migraines warranted?
Definition
If attacks interfere with QoL,

or

3 or more attacks per month that fail to respond to symptomatic therapy
Term
Which BBs used for prophylaxis ? Which cause fewer CNS SE's?
Definition
Propranolol - most studied

Nadolol & atenolol have fewer CNS effects because they do not cross the BBB
Term
CCBS in HA prophylaxis?

Which vs. cluster?

Which vs. Migraine?
Definition
Verapamil vs cluster

Flunarizine vs migraine
Term
TCAs for HA?

Do they produce dependence?
Definition
Amitriptyline, nortriptyline, doxepin effective for tension HA

DO NOT produce dependence
Term
What antiepileptic drugs are good prophylaxis for HA?

Special note about these?
Definition
Valproic Acid and divalproex sodium good migraine prophylaxis

BOTH TERATOGENIC!
Term
In what patients should topiramate be avoided for HA prophylaxis ?

Side effect? Positive side effect?
Definition
Avoid in Renal stones

Can increase ocular pressure and cause weight loss
Term
Serotonin Antagonists used for prophylaxis vs HA?
Definition
Pizotifen - Maximal dosage, if tolerated

Methysergide - REMOVED FROM MARKET due to long term SE's
Term
Riboflavin efficacy in migraine prophylaxis?
Definition
YES
Term
What can lithium be used for in HA prophylaxis?
Definition
Cluster HAs
Term
Most common time for migraines in pregnancy?
Definition
Postpartum
Term
First line for mild HA in pregnancy/postpartum
Definition
Lifestyle changes, occasional APAP
Term
When should Ibuprofen or Naproxen be avoided in pregnancy?
Definition
Avoid in later stages... Can be used during first or second trimester ONLY
Term
Ergot derivatives in pregnancy?
Definition
TERATOGENIC
Term
ASA in pregnancy
Definition
AVOID
Term
Barbiturates in pregnancy
Definition
AVOID
Term
Indomethacin in pregnancy
Definition
AVOID
Term
Triptans in pregnancy
Definition
AVOID
Term
Preferred Severe HA prophlyxis in pregnancy
Definition
Propranolol
Term
Acetaminophen in breastfeeding?
Definition
OK!
Term
Triptans in Breastfeeding?
Triptans in Pregnancy?
Definition
OK in breastfeeding - most studied
AVOID in pregnancy
Term
HA prophylaxis while breastfeeding?
Definition
Propranolol
Term
Divalproex Sodium as prophylaxis in breastfeeding?
Definition
OK!
Term
Important counseling point of triptans
Definition
Do not use a triptan within 24 hours of another triptan

Do not use more than 10 times per month
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