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Headache Disorders
PTX2 Week1
83
Other
Professional
08/30/2011

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Cards

Term
How are headaches classified?
Definition

Primary = no underlying pathology

Secondary = underlying pathologic condition

Term
List the 3 types of Primary Headaches
Definition

1. Migraine (can be w/ or w/out an Aura)

2. Tension Type

3. Cluster headache

Term
What are the severity levels of a headache?
Definition

1. Mild = can do daily routine

2. Moderate = inhibits daily acitivity but not incapacitating

3. Severe = Incapacitating

4. Status = Severe headache lasting > 72 hrs

Term
How do you diagnose headaches, in general?
Definition

1. Rule out secondary causes by checking for abnormalities (vital signs, neurologic exams, etc)

2. Headache history questions (characteristic of pain, Rx used, impact on life, family hx, etc)

Term
What type of questions are on a headache diary?
Definition

1. Date

2. Time (start/finish)

3. Intensity (scale of 1-10 (most severe))

4. Preceding symptoms

5. Triggers

6. Medication and dosage

7. Relief ?

Term
Are migraines higher in men or women?
Definition

Women (18%)

Men (6.5%)

Term
What is the age of onset for migraines? When does it peak?
Definition

10-29 yro

 

Peak at 35-45 yro

Term
Migraines are a feeling of throbbing head pain (recurrent) in ________________location.
Definition
Unilateral
Term
Migraines can occur at any time of the day but most commonly it occurs in ____________ and can last from ____________ hrs.
Definition

The a.m. when you first wake

 4-72 hrs

Term
List some symptoms of migraines.
Definition

1. Sensitivity to light & sound

2. Blurr Vision

3. Nausea/Vomitting

4. Diarrhea

5. Constipation

6. Anoxeria

7. Food cravings

8. Localized edema

9. Ab cramps

10. Nasal stuffiness

Term
To be diagnosed with a migraine w/out Aura you need to have at least ____________ attacks whereas a migraine w/ an Aura you need to have at least _________attacks.
Definition

5

 

2

Term
An aura symptoms lasts between _______ and _______ mins.
Definition

> 5 mins

< 60 mins

Term
What is an example of a positive aura symptom?
Definition
Tingling
Term
What are some triggers to migraines?
Definition

1. Environment (small, light, loud noise, etc)

2. Behavioral/physiologic ( stress, no sleep, skipped meals, etc)

3. Rx

4. Food (caffeine, EtOH, aged cheeses, Chocolate, nitrates, nuts, etc)

Term
What is a non pharmacological approach to treat migraines?
Definition

1. Avoid triggers

2. Apply ice to head

3. rest in dark place

4. Good eating habits

5. Stop smoking

6. Limit caffeine

7. Regular sleep and exercise

Term
T/F:  There are some OTC products that are better to treat migraines.
Definition
False; no OTC is better than the other. It depends on the patient
Term
Most patients seek self treatment. When should they be reffered to a physician?
Definition

1. If > 50% disability (daily activities)

2. > 20% vomiting

3. If < 15 days/ month are headache free

4. Failure of 2 or + OTC products

Term
What does A-U-S-T-I-N stand for?
Definition

A = Aggravation by activity

U = Unilateral location

S = Sensitivity to light/sound

T = Throbbing

I = Intensity

N = Nausea/Vomitting

Term
Patients should limit the use of OTC to ___________ days per week; trying to avoid over use headaches
Definition
2
Term
Ken comes to the pharmacist and tells you this is the 4th OTC product he is trying to treat his headache.  What do you tell him?
Definition

Refer to doctor.

Failure of 2 or more OTC products need referral

Term
Why is stratified care the most beneficial approach compared to step care, when treating migraines?
Definition

1. It assests the headache and treats based on the severity.

2.   It can be cheaper for the patient.

3. Patient specific

4. Greater response rate

Term
If we are using the stratified care to treat Migraines how do we approach the different levels of disabilities?
Definition

Low disability = OTC

Moderate disability = OTC and Rx

Sever Disability =  Migraine Rx and Preventative Rx

Term
T/F: Stratified Care approaches each patient the same and is lost to follow up/treatment failures.
Definition
False; this describes Step Care
Term
Does acute treatment of migraines effect auras?
Definition
No
Term
Why do you want to limit the use of OTC treatment to 2-3 / week?
Definition
To prevent overuse headaches
Term
How many headache episodes should you treat on your own?
Definition
5
Term
For moderate to severe headaches use ______________.
Definition
Rx drugs
Term
List the Rx used for moderate to severe migraines.
Definition

1. Ergotamines

2. Triptans

3. Opiods

4. NSAIDs

5. Corticosteroids

6. Butorphanol Nasal spray

7. Antiemetics

Term
If a patient has a severe migraine and nausea/vomitting what should they take?
Definition

 A anti-emetic before treating

or

use a non oral Rx

Term
What is one advantage of the use of ergotamines?
Definition
They have many dosage forms.  From oral to rectal to intranasal, parenteral.
Term
T/F: Ergotamines have many ADRs, the most common is nausea and vomitting. 
Definition
True
Term
If your taking an ergotamine, what should be avoided for 24hrs?
Definition
Triptans
Term
What patients cannot use Ergotamines?
Definition

1. Pregnant

2. Renal/liver failure

3. Nursing

4. Uncontrolled HT

5. Sepsis

6. Coronary, cerebral, or peripheral vascular disease

Term
What triptan is considered the gold standard?
Definition
Sumatriptan (Imitrex)
Term
What is the best triptan to use?
Definition

Whichever is best for the patient.

It varies by:

onset/duration

efficacy

drug interactions

metabolism

ADR

Term
What is the only first generation triptan?
Definition
Sumatriptan
Term
What are some benefits of 2nd generation triptans?
Definition

1. lower headache recurrence rate

2. Shorter onset action

3. Fewer ADR

Term
What are some side effects you need to counsel your patient who are taking a triptan?
Definition

May experience: dizziness, drowsiness, tingling and chest pain.

BUT

if they dont get relief within 30-45 mins they want to seek medical attention *may b a stroke*

Term
If a patient is taking Rizatriptan and Propanilol, what should you do to the dose of the Rizatriptan and why?
Definition

Reduce the dose by 50%.

 

The Propanilol increases the concentration of Rizatriptan by 70%.

Term
What is Treximet?
Definition

A combo Rx

 

85mg Sumatriptan with 500 mg Naproxen

Term
What is the dosing for Treximet?
Definition

1 tablet at onset of headache and may repeat in 2 hrs.

 

Max = 2 tablets/24 hrs

Term
What is Cambia?
Definition
Diclofenac and KHCO3 50 mg soluble powder
Term
T/F: Cambia should be taken on an empty stomach only.
Definition
False; It does improve its efficacy if taken on empty stomach but you may want to take with food to protect the stoamch
Term
When should prophylactic treatment used for migraines?
Definition

1. 4 or more migraines a month

2. Contraindication or ADR w/ acute Tx

3. Cost

4. Predictable headache patterns

5. Disability even after being treated

Term
With prophylactic treatment you want to start _______ and go _______.  It takes about ________ to measure efficacy.
Definition

Low

Slow

2-3 months

Term
What is type of Rx is considered to be first line when it comes to prophylactic treatment?
Definition
Beta Blockers (80% effective)
Term
Which Beta Blocker is the DOC for prophylactic treatment?
Definition
Propranolol (80-240 mg/day divided)
Term
The anticonvulsant Topiramate can cause _______________ so you want to counsel your patient to drink with a full glass of water.
Definition
Kidney stones
Term
Valproaic acid can cause ____________________ that is why you want to measure/check ____________.
Definition

Hepatotoxicity

Liver enzymes

Term
NSAIDs as prophylatic therapy is mainly used in preventing headaches that recur _________________.
Definition
in a predictable pattern like period migraines
Term
What is the most common cause of chronic daily headaches?
Definition

Overuse of headaches medications

 

Taking Rx 10-15 days/month

Term
What can you use for menstrual migraines?
Definition

Tx 2-3 days prior to onset of menses

 

NSAIDs

Triptans

Estrogen

Term
If a migraine is induced by birth control, what can a patient do/use?
Definition

1.Change the formulation

2. Take a progestin only pill

3. Discontinue the OC

4. Start B6 vit.

 

Term
What Rx can a pregnant women use to treat migraines?
Definition
Triptans
Term
If pregnant when prophylactic treatment should be avoided and why?
Definition

Valproic acid = Tetratogenic

NSAIDs  in 3rd trimester

Term
What is the 2nd/3rd DOC for prophylatic treatment?
Definition

Verapamil (most common)

and

Nifedipine

Term
Mg can be used as a prophylatic treatment.  What is the major side effects associated with it?
Definition

Soft Stools/Diarrhea

Palpitations

Term
What is the most common type of primary headache?
Definition
Tension type headaches
Term
T/F: Onset of tension headaches is early in life. 40% is younger than 20 yro.
Definition
True
Term
What is the clinical presentations of a tension headache?
Definition

1. Mild to moderate pain

2. Can last 30 mins to 7 days

3. Dull, nonpulsatile tightness or pressure

4. Bilateral location

5. Mild photophobia/phonophobia

6. Not that disabling

Term
How are Tension Headaches classified?
Definition

Episodic

Chronic

Term
What are episodic tension headaches?
Definition

Headaches occuring > 1 day but < 15 days a month

(< 180 days/yr)

Term
What are Chronic Tension Headaches?
Definition

Headaches that occur > 15 days/month

or

(>180 days/yr)

Term
What can you use to treat mild to moderate tension type headaches?
Definition

1. NSAIDs

2. Simple Analgesics

Term
When should prophylatic treatment occur when having tension type headaches?
Definition
When they have a headache frequency of more than 2x/week lasting for more than 3-4 hrs.
Term
What is the most effective prophylatic treatment for Tension Type Headaches?
Definition
TCAs
Term
Of the primary headaches which is the most severe form?
Definition
Cluster Type headaches
Term
Cluster Type Headaches is more common in _______________.
Definition
Men
Term
What are the clinical presentations of Cluster Headaches?
Definition

1. Occur suddenly w/no auras

2. Excruciating/penetrating pain lasts 15-180 mins

3. Dull intensity

4. Lacrimation

5. Facial Sweating

(more symptoms--those are the main)

Term
T/F: Cluster headaches occur mostly at night, and you can have up to 8 attacks a day.
Definition
True
Term
How do Cluster attacks occur?
Definition
In periods of attacks lasting 2 wks to 3 months followed by a long pain free interval (can b 2 months to 20 yrs)
Term
An Episodic Cluster Type headache is classified by having attacks lasting _________ to _______ w/pain free period lasting 1 month or longer.
Definition

7 days

1 yr

Term
T/F: Chronic Cluster Type Headaches are classified as attacks lasting more than 1 yr w/out remission or with remission lasting less than 1 month.
Definition
True
Term
What are some Acute treatment options for Cluster Type Headaches?
Definition

1. O2

2. Ergots

3. Triptans

Term
Which Triptan is the most effective for acute treatment of Cluster Headaches?
Definition
SQ Sumatriptan 6 mg
Term
What are some prophylatic treatment options for Cluster Headaches? In what doses?
Definition

1. Lithium (600-1200 mg/day)

2. Verapamil (360- 720 mg/day)

3. Lithium + Verapamil

4. Methylsergide (4-8 mg/day)

5. Corticosteroids (40-60 mg/day)

6. Ergots (1-2 mg/day)

Term
When it comes to location, both migraine and cluster headaches are ______________, whereas Tension headaches are ____________.
Definition

Unilateral

Bilateral

Term
List the duration of migraine, tension and cluster headaches.
Definition

Migraine = 4 hrs to 72 hrs

Tension = 30 mins to 7 days

Cluster = 15 minutes to 180 minutes

Term
Before puberty, do boys or girls have a higher incidence of headaches?
Definition

Boys do!

But after puberty, because of estrogren flux, migraines and tension headaches are greater in girls.

Term
What are some acute treatment options for children w/ headaches?  Provide the doses
Definition

1. Acetamenophen = 15 mg/kg/dose

2. Ibuprofen = 10 mg/kg/dose

3. Naproxen = 2.5-5 mg/kg/dose

Term
When should children seek prophylatic therapy for their headaches?
Definition

1. If its severe in nature

2. At least 3 headaches/month

3. Functional disability

Term
T/F: Triptans are FDA approved for use in children.
Definition
False; not approved  but has shown to be efficacious in > 12yro
Term
Which is the preferred prophylactic treatment for cluster headaches?
Definition
Verapamil
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