Term
| Abortive Migraine Treatment |
|
Definition
| NSAIDs, aspirin, opioids, antiemetics, triptans, ergot derivatives |
|
|
Term
| First line therapy (abortive treatment of migraines) |
|
Definition
| Ibuprofen, Naproxen, Ketoprofen, Diclofenac potassium, aspirin, acetaminophen/aspirin/caffeine |
|
|
Term
| Used as monotherapy, great for patients with N/V, (migraine abortive treatment) |
|
Definition
| Metoclopramide (Reglan) intravenous |
|
|
Term
| Side effects of Metoclopramide |
|
Definition
| sedation, EPS, seizure, arrhythmias, diarrhea |
|
|
Term
| used as a migraine abortive due to its vasoconstrictive properties |
|
Definition
| Isometheptene and combination |
|
|
Term
| not effective as migraine abortives |
|
Definition
| IV corticosteroids, intranasal lidocaine |
|
|
Term
| reserved as last line in migraine headaches. can exacerbate N/V |
|
Definition
|
|
Term
| only agent with consistent migraine relief |
|
Definition
|
|
Term
| 5HT Agonist with the greatest efficacy in migraines (relief at 2 hours, freedom of pain, sustained pain-free (24 hr) |
|
Definition
|
|
Term
| lowest efficacy of 5HT Agonists |
|
Definition
| naratriptan = frovatriptan |
|
|
Term
| onset of action of Rizatriptan |
|
Definition
| < sumatriptan and naratriptan; = zolmitriptan |
|
|
Term
| sumatriptan IN< sumatriptan PO |
|
Definition
| onset of action of sumatriptan |
|
|
Term
| Sumatriptan po vs. other therapy |
|
Definition
= ASA and naratriptan;
> ergotamine + caffeine |
|
|
Term
| Eletriptan vs. other therapy |
|
Definition
|
|
Term
| Rizatriptan vs. other therapy |
|
Definition
|
|
Term
| Contraindications to Triptans |
|
Definition
| Ischemic heart disease, variant angina, cerebral/peripheral vascular disease, uncontrolled hypertension, pregnancy, ergot alkaloid past 24 hr, MAOIs past 2 weeks, hemiplegic and basilar migraine |
|
|
Term
|
Definition
| caution and concomitant use |
|
|
Term
|
Definition
| tingling, numbness, warm/hot sensations, pain or tightness, dizziness, sedation |
|
|
Term
| Rizatriptan drug interactions |
|
Definition
|
|
Term
| Eletriptan drug interactions |
|
Definition
|
|
Term
|
Definition
|
|
Term
| use at onset of attack, if pain or tightness in chest call MD |
|
Definition
|
|
Term
| MOA on 5HT (IB/ID) receptor for Ergotamine |
|
Definition
|
|
Term
| MOA on 5HT (2A) receptor for ergotamine |
|
Definition
| generalized vasoconstriction |
|
|
Term
| MOA on D2 receptor for ergotamine |
|
Definition
|
|
Term
|
Definition
| not considered first line, low bioavailability, rectal suppository: 1-2 mg |
|
|
Term
| higher safety and efficacy; < 5HT (2A) and < D2; available IV and intranasally |
|
Definition
|
|
Term
| Ergot compounds side effects |
|
Definition
| N/V, numbness and tingling, muscle pain/weakness in less, tachycardia/bradycardia, itching |
|
|
Term
| Ergot compounds contraindications |
|
Definition
| pregnancy, PVD, CAD, HTN, hepatic/renal impairment |
|
|
Term
| Ergot compounds drug interactions |
|
Definition
| beta blockers (increased risk of gangrene), nitrates and other vasodilators |
|
|
Term
| Initiate at 1st sign of attack, adhere to max doses (Rebound HA), report s/s of ischemia |
|
Definition
|
|
Term
| potentiates vasoconstriction, improves intestinal absorption of ergotamine, potentiates pain relief properties of analgesics |
|
Definition
|
|
Term
| uncommon migraines that require preventative therapy |
|
Definition
| Hemiplegic migraine, prolonged aura, migrainous infarction |
|
|
Term
| DOC for migraine prevention due to safety, efficacy, and tolerability |
|
Definition
| Propranolol 80-240 mg/day |
|
|
Term
| good preventative choice for mixed tension/migraine; beneficial if underlying depression |
|
Definition
| Amitriptyline (1st line therapy) |
|
|
Term
| preventative migraine medication especially useful for pts with prolonged or atypical aura |
|
Definition
|
|
Term
| preventative med for migraines; limited use due to propensity for severe ADRs; drug holidays needed every 6 months |
|
Definition
|
|
Term
| Preventative med for migraines; delay 1-2 months for effect; |
|
Definition
|
|
Term
| preventative med for migraines; modest efficacy; good choice for menstrual migraines |
|
Definition
|
|
Term
| migraine prevention: In clinical trials decreased attacks/month be 2 vs reductions with placebo of 1; 100 mg/day similar efficacy to propranol 160 mg/day in one study; Much more expensive than BB (<$200 vs $30) |
|
Definition
|
|
Term
| 5:4 Female:Male; average 46% of adults suffer from these |
|
Definition
|
|
Term
| activation of hyperexcitable peripheral neurons |
|
Definition
| most likely the cause of infrequent form of tension headaches |
|
|
Term
| Episodic, Infrequent Tension HA |
|
Definition
| 10+ episodes, occurring on < 1 day/month average; <12 days/year and fulfilling other requirements for Tension HA |
|
|
Term
|
Definition
| 10+ episodes, occurring on 1 to > 15 days/month for 3 + months (12 to <180 days/year), and fulfilling other criteria for tension HA |
|
|
Term
|
Definition
| HA occurs on 15+ days/month average for > 3 months (180 + days/year) and fulfilling other criteria for tension HA |
|
|
Term
| Tension HA must have 2+ of the following |
|
Definition
| bilateral location, pressing/tightening quality, mild to moderate intensity, not aggravated by routine activity |
|
|
Term
|
Definition
| lasting 30 minutes-7 days |
|
|
Term
| Tension HA must have both of the following |
|
Definition
| no more than one of photophobia, phonophobia, mild nausea; neither moderate or severe nausea nor vomiting |
|
|
Term
| Tension Headache Triggers |
|
Definition
| stress, sleep deprivation, bad posture, irregular meal time, eye strain, jaw clenching/teeth grinding |
|
|
Term
| best evidence; 75% of patients reported relief after 2 hours (Abortive treatment for tension headache) |
|
Definition
|
|
Term
| mixed results; less effective than NSAIDs; abortive treatment for tension headache... |
|
Definition
|
|
Term
| effective for tension headache |
|
Definition
|
|
Term
| tension headache preventative treatment |
|
Definition
| consider withdrawing abortive meds first |
|
|
Term
| drug of choice for preventative med tension headache; relieves pain and muscle tenderness |
|
Definition
| Amitriptyline 75-150 mcg per day |
|
|
Term
| side effects of Amitriptyline |
|
Definition
| anticholinergic, weight gain (up to 25%) |
|
|
Term
| preventative med tension headache; used in chronic type; up to 18 mg daily |
|
Definition
| Tizanidine: alpha agonist |
|
|
Term
|
Definition
|
|
Term
| 15-30 mg daily: Tension headache preventative medication |
|
Definition
|
|
Term
|
Definition
| tension headache prevention |
|
|
Term
| activation of the trigeminal-vascular system; problem with regulating center in the hypothalamus; alteration in hormone secretion; melatonin alterations |
|
Definition
| Cluster HA pathophysiology |
|
|
Term
| Triggers for cluster headaches |
|
Definition
| alcohol, vasodilators, stress, warm weather, missed meals, excessive sleep |
|
|
Term
| abortive treatment of cluster headaches |
|
Definition
| rapid acting therapies preferred; sumatriptan SQ, Zolmitriptan (nasal); |
|
|
Term
| DOC; decreases severity within 15 min, uncommon severe adverse effects, no prophylactic effect |
|
Definition
|
|
Term
| pain relief at 30 minutes, not effective for chronic cluster headache |
|
Definition
|
|
Term
| pain relief over 5-15 min; more effective in episodic type attacks; may merely delay rather than abort attacks |
|
Definition
|
|
Term
| not FDA approved, efficacy questionable; thought to block painful impulses through sphenopalatine ganglion |
|
Definition
|
|
Term
| intranasal lidocaine side effects |
|
Definition
| bitter taste, burning sensation, oropharyngeal numbness |
|
|
Term
| ergotamine inhalation in cluster headaches |
|
Definition
| benefit in old trials; limited AEs, chronic use can lead to dependence |
|
|
Term
| Dihydroergotamine in cluster headaches |
|
Definition
| inhaled or SQ can be used; decreased AEs |
|
|
Term
| limited efficacy in cluster headaches; poor absorption; toxicity and habit forming; medication overuse headache |
|
Definition
|
|
Term
| preventative treatments of cluster headaches |
|
Definition
| CCBs, ergotamine, corticosteroids, lithium |
|
|
Term
| preventative treatment of cluster headache DOC; can be combined with lithium |
|
Definition
|
|
Term
| Verapamil adverse effects |
|
Definition
| constipation, postural hypotension, water retention, fatigue |
|
|
Term
| good for short, mild cluster HA periods; don't combine with triptans! |
|
Definition
|
|
Term
| quickly reduces the number of attacks of cluster HAs; most beneficial for episodic type; limit treatment to 3 weeks |
|
Definition
| high doses of dexamethasone and prednisone |
|
|
Term
| used for both chronic and episodic cluster HA prevention; can combine with steroid therapy; monitor renal, thyroid and drug levels |
|
Definition
|
|
Term
|
Definition
| tremors, polyuria, and diarrhea |
|
|
Term
|
Definition
| indomethacin, diclofenac, thiazides |
|
|
Term
| other cluster HA preventative drugs |
|
Definition
| topiramate, methysergide, valproic acid, melatonin, baclofen, and transdermal clonidine |
|
|
Term
|
Definition
| tingling, weight loss, neurocognitive impairment |
|
|
Term
| semi-synthetic ergot alkaloid |
|
Definition
|
|
Term
|
Definition
| atypical pattern of HA, history of seizure, neurological signs or symptoms, symptomatic illness |
|
|
Term
| headache is present on 15+ days/month; intake of precipitating agents on 10+ days/month, regular overuse for 3+ months; HA resolves within 2 months after stopping medication |
|
Definition
| Medication Overuse Headache |
|
|
Term
| some prophylactic therapy for MOH |
|
Definition
| long acting NSAIDs, Amitriptyline, Nausea medications |
|
|
