HA

Question 0

ACUTE therapies for cluster headaches (4)

Answer 0

1. O2
2. triptans (Sumatriptan (1st line therapy))
3. DHE
4. anesthetics (lidocaine)

Question 1

ACUTE tx of MIGRAINES (either alone or in combo with acetaminophen, asa, caffeine) and their CI’s.

Answer 1

1. analgesics (inhibits COX (COX2 is preferred))
2. barbs (used when traditional therapies dont work/CI): SE - drowsiness/dizziness
3. opioids (infreq HA’s (for pts who wake up with HA)) (pregant women –> use codeine or meperidine with caution)
4. corticosteroids
5. Ergotamines (specific for migraines) (CI in women planning pregnancy, uncontrolled HTN, sepsis, renal/hepatic failure, vascular dz)
6. DHE (dihydroergotamines): same CIs as 6, but less rebound HAs than 5, and is injectable
7. Sumatriptan (premier option): CI in vascular dz, uncontrolled HTN, complicated migraines; injectable.
8. onabotulinum toxin: for acute tx of chronic migraine HAs.

Question 2

prophylactic therapies for CH: short/long term

Answer 2

short term preventives: corticosteroids and ergotamine

long term preventives: verapamil, topiramate, divalproex sodium, lithium

Question 3

analgesics

Answer 3

1. acute migraine (combo with acetaminophen, asa, caffeine)

2. acute Tension HA

Question 4

barbs

Answer 4

1. acute migraines (when traditional therapies CI)

SE: dizziness/drowsiness

Question 5

opioids

Answer 5

1. acute migraines
2. infreq HAs (for those who wakes up with HA)
   
   • pregnant women use codeine/meperidine with caution

Question 6

corticosteriods

Answer 6

1. acute migraines
2. prolonged HA sds (chronic daily Ha)
3. rescue tx for cluster HAs

-overuse –> most common cause of chronic daily HAs

Question 7

which group (and what are the 2 drugs) that produces vasoconstriction, and 5HT agonist in trigeminovascular pathway?

Answer 7

ergotamines and DHE

Question 8

which drugs are contraindicated in women planning pregnacy, uncontrolled HTN, sepsis, renal/hepatic failure, vascular dz

Answer 8

ergotamine and DHE

Question 9

contraindicated in vascular dz, uncontrolled HTN, complicated migraines; injectable

Answer 9

sumatriptan

Question 10

selective 5HT1b-d agonist
penetrates CNS
constricts extracerebral intracranial vessels
inhibits trigeminovascular sys

Answer 10

sumatriptan

Question 11

effective for: acute migraines (premier option), photo/phonophobia, N/V, acute tx of cluster HA

Answer 11

sumatriptan

Question 12

injection site pain, HA, neck weakness, ptosis

Answer 12

botox

Question 13

which TCAs are for migraine PREVENTION, and tension headache PREVENTION?

Answer 13

amitriptyline, protriptyline, nortriptyline

Question 14

which SSRIs are for migraine PREVENTION, tension HA PREVENTION?

Answer 14

fluoxetine, paroxetine, sertraline

Question 15

bblockers for migraine PREVENTION and CI?

Answer 15

propanolol, timolol

CI: asthma, diabetes, CHF, Raynaulds

Question 16

Ca channel blocker foR:

• migraine PREVENTION (particularly useful in prolonged or disabling aura, or complicated migraine sds (hemiplegic migraine)
• long term prevention of cluster HAs

Answer 16

verapamil

Question 17

O2

Answer 17

acute tx of cluster HAs; rebound can occur when O2 stopped.