Duke PA Pharmacology Headache
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| non-specific (symptomatic) treatment of migraines | analgesics, antiemetics
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| reserved as a rescue medication when other treatments of a severe migraine attack are not successful | opioids
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| specific migrain therapy includes __ which are both 5-HT(1D)receptor agonists | triptans and dihydroergotamine
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| despite the high cost most patients prefer __ over ergot derivatives | triptans
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| these agents rapidly and effectively abort or markedly reduce the severity of migraine headaches in about 70% of patients | triptans
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| significant __ have been reported with triptan use | elevation of blood pressure and cardiac events
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| triptans should not be administered to patients with risk factors for __ without evaluation | coronary artery disease
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| __ is a common AE of dihydroergotamine | nausea
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| therapy to prevent migraine is indicated if the attacks occur __ or more times per month and if the headaches are severe or complicated by serious neurologic signs | 2
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| __ is the drug of choice for migraine prophylaxis | propranolol
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| the classes of drugs that are effective in reducing the frequency and severity of migraine attacks | beta-blockers, tricyclic antidepressants, anticonvulsants, calcium-channel blockers
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| dihydroergotamine is a vasoconstrictor. It is contraindicated in __ | pregnancy, PVD, or CAD
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| antiemetic used during a migraine | prochlorperazine
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| the pain of migraine may be due to __ | extracranial and intracranial arterial dilation
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| agents used to treat an acute migraine attack | triptans, dihydroergotamine, analgesics
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| agents best used during the prodromal stage of migraine | triptans, dihydroergotamine
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| two major types of tension-type headaches | episodic, chronic
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| episodic type of tension-type headache | attacks occur an average of 3 days/month
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| chronic type of tension-type headache | 15 or more attacks/month
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| over the counter analgesics for tension-type headache | ibuprofen, naproxen, aspirin, acetaminophen, excedrin tension HA
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| patients with tension-type headache that don't respond to OTC analgesics may require | prescription NSAIDS
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| if medication for tension-type headache is needed more than 2 days/week consider __ | prophylaxis
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| chronic daily headache may occur with overuse of __ | analgesics
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| in rare instances __ may be used for patients with intractable tension-type HA | butalbital combination products (Fiornal or Fioricet), Midrin, or APAP + opioid combinations
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| what is in Midrin | isometheptene 65mg + dichloralphenazone 100mg + APAP 325mg
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| what is in Excedrin Tension HA | APAP 500mg + caffeine 65mg
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| can be used to help wean people off daily analgesic use | tizanidine (Zanaflex)
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| prophylactic therapies for chronic or frequent tension-type HA | tricyclic antidepressants (amitryptyline), skeletal muscle relaxants (methocarbamol)
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| __ injections into cranial muscles may be benificial in some patients with tension-type HA | botulinum toxin
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| side effects of TCA's (Amitriptyline/Nortriptyline) are __ | weight gain, dry mouth, constipation
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| TCA's are contraindicated in __ | severe heart disease
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| used for patients with major depressive disorder and chronic daily headache | duloxetine (Cymbalta)
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| __ has significant anticholinergic effects | amitriptyline
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| __ should be taken at first sign of neck or head tension as prophylaxis, preferably at bedtime | muscle relaxants
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| muscle relaxants used for Tension-type headaches | cyclobenzaprine (flexaril), methocarbamol (robaxin), tizanidine (Zanaflex)
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| monitor __ periodically with chronic use of muscle relaxants | LFTs
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| when using muscle relaxants watch drug-drug interactions with | ciprofloxacin, fluconazole, famotidine, oral contraceptives, acyclovir
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| about __% of migraines present without aura | 80
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| about __% of migraines present with aura | 20
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| nonpharmacologic therapy of migraine | diet, sleep, stress management, cognitive-behavioral measures
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| consider __ for patients with incomplete response to acute therapies | prophylactic migraine therapy
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| abortive non-opioid therapy for migraines | NSAIDS, aspirin, and acetaminophen
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| Excedrin Migraine is a combination of | aspirin/APAP/caffeine
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| possible SE of non-opioid abortive migraine therapy with chronic use | rebound HA
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| SE of NSAIDS, aspirin, APAP | GI toxicity, rebound HA, sodium and water retention, renal dysfunction, exacerbation of HF, antiplatelet effects,
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| MOA of triptans | constrict intracranial blood vessels (5-HT1B), inhibit vasoactive neuropeptide release (5-HT1D), & interrupt pain signal transmission centrally (5-HT1D)
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| AE's of triptans | paresthesisas, fatigue, dizziness, flushing, warm sensations,somnolence, chest tightness, possible rebound HA with overuse
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| triptan contraindications | ischemic heart disease, uncontrolled hypertension and cerebrovascular disease, basilar or hemiplegic migraines
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| NSAIDS, ASA, APAP contraindications | h/o GI bleed, renal insufficiency, hepatic failure(APAP)
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| triptan drug-drug interactions | MAOI's, ergot, caution with SSRI's(serotonin syndrome), some 3A4 interactions
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| do not give triptans to anyone with | heart disease
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| used for menstrual migraines b/c of the predictability of the HA. this drug has a slow onset and a long duration | naratriptan (amerge)
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| treximet is a combination of | 85mg sumatriptan and 500mg of naproxen sodium
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| benifit of treximet combo is | decreased need for rescue medication withing 24 hours compared to either drug alone
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| __ injection can be given to break a chronic HA cycle | ergotamine
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| SE of Ergotamine | vasoconstriction, HTN, peripheral ischemia, N, V, D, pruritus, vertigo, cramps, paresthsias, cold skin, dec. pulses in extremities; rebound HA, fibrosis long term
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| contraindications for ergotamine | CAD, PVD, HTN, liver/kidney dz., protease inhibitors, pregnancy (X)
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| must stop __ 24 hours before ergotamine injection | triptan
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| antiemetics | prochlorperazine, metoclopramide
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| SE of antiemetics | sedation, extrapyramidal effects, anticholinergic effects
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| other abortive therapy for migraine | intranasal lidocaine, corticosteroids, droperidol, nitrous oxide, propofol
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| prophylactic therapy | beta blockers, TCA's, SSRI's, atypical antidepressants (bupropion, venlafaxine), MAOI
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| FDA approved migraine prophylactic beta blockers | propranolol and timolol
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| SE of beta blockers | sedation, fatigue, dizziness, depression, orthostatic hypotension, impotence
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| contraindications for beta blockers | asthma, CHF?, PVD, IDDM?
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| most studied TCA for migraine prophylaxis | amitriptyline
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| abortive therapy for cluster headache | oxygen (#1), DHE-45, sumatriptan or zolmitriptan, intranasal lidocaine
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