N L 10 Tx of HA Zhao
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34 terms
Terms | Definitions |
|---|---|
 What are the three types of primary headaches? | (1) Migraine (#1 studied headache), (2) Tension (90% of headaches are this type) (3) Cluster (most severe type) |
| What are the two types of HA therapy? | (1) symptomatic aka 'abortive'-take at 1st sign of HA (2) prophylactic |
| What are the triggers of migraines? | Stress, hunger, alcohol, menstruation, sex, food, food additives |
| What is the most severe type of headache? | Cluster HA |
| What are the two theories of HA pathogenesis? | Vascular basis theory and depression of electrical cerebrocortical activity |
| What are the 3 neuropeptides that cause vasodilation and vascular permeability? | 1. calcitonin gene related peptide (CGRP) 2. substance P (SP) 3. neurokinin A (NKA) |
| What vascular system represents the most important anatomic and functional area for the study of headache pathology? | trigeminal vascular system |
| What are acetaminophen or aspirin commonly combined with to absorption and effectiveness? | Caffeine |
| Why is combining caffeine w/NSAIDs a good idea? | This combination allows for a lower necessary dose of NSAIDs due to the absorption, which is beneficial bc NSAID's wreck the gut. |
| What is the mechanism of a HA? | Trigger⇒vessels dilate bc of CGRP, SP, NKA⇒ the primary afferents sensitized⇒neurogenic inflammation⇒conduction to the trigeminal nuclear complex⇒the complex relays to both the limbic system and the thalamus⇒cerebral cortex |
| What symptoms MUST be gone in order for the treatment of a HA to be considered successful? | ➢ the symptoms must be gone w/in 2hrs of the initiation of therapy ➢ symptoms must not reoccur w/in 24hrs |
| What drugs are ABSOLUTELY contraindicated in pregnancy? | Ergot alkaloids are absolutely contraindicated in pregnancy |
| What is the difference between Migraines with and w/o aura? | The "aura": 1hr prior to onset, characterized by visual scintillations, zigzag lines, photophobia, dizziness and tinnitus |
| Which migraine is more common with or w/o aura? | Migraine with aura is less common |
| Migraine Tx DOC | Triptans are DOC, with NSAIDs and ergots being alternatives |
| What headache has unilateral orbital or temporal pain that is intense and steady w/tearing, rhinorrhea, miosis, ptosis, flushing and edema (autonomic symptoms) | Cluster(aka "suicide headaches") |
| When do cluster headaches occur? | They occur 2-3 hrs after falling asleep, lasts 1-2 hrs |
| What are the two types of cluster headaches? | ➢ Episodic (85%): 2attacks/day for weeks-mo., w/mo-yrs of remission ➢ Chronic (15%): attacks occur for a year or longer, few or no periods of remission |
| What triggers cluster headaches? | Alcohol, sex, lying down |
| What's must one have in order to be diagnosed w/cluster HA ? | MUST have at least one autonomic symptom to be a cluster HA |
| Whats used for ACUTE treatment of cluster HA? | subQ sumatripan is the DOC for ACUTE cluster HA |
| What is the DOC for Tension HA? | DOC#1 acetaminophen OR aspirin +caffeine DOC#2 NSAIDS (naproxen, ibuprofen, ketorolac) |
| How does caffeine interact with NSAIDS? | absorption and effectiveness by 40% and max dose required |
| Triptans MOA | Bind serotonin 5-HT1B and 5-HT1D receptors in cranial blood vessels causing them to constrict, and subsequent inhibition of pro-inflammatory neuropeptide release |
| Triptans | ➢ Sumatriptan is the prototype ➢ Frovatriptan-longest T1/2 =26hrs, 4 HA that coincides w/menstruation ➢ Naratriptan has a medium T1/2=6hrs ➢ Others have short T1/2=1-2hrs |
| Triptans CI | Pts w/ ischemic heart disease or pt taking ergot alkaloids |
| Ergot MOA | Partial agonis at α-adrenoceptors and the 5-HT(1B and 1D) Receptors, stimulates serotonin signaling, inflammation, and reverses blood vessel dilation around the brain |
| What is Ergotamine? | It's the MAINSTAY drug and used in combo with caffeine to efficacy(drug name changes to Cafergot when caffeine+) |
| When are Ergots ABSOUTELY contraindicated? | Ergots are ABSOLUTELY contraindicated in pregnancy (not a teratogen, it will actually KILL the fetus) |
| Analgesics(she focused a little on them) MOA | Inhibit COX/prostaglandins |
| What are analgesics used for? | Theyre useful for migraines, tension, cluster HA |
| What analgesics are useful for ACUTE treatment? | Aspirin and NSIADS(naproxen and ibuprofen), as well as acetaminophen |
| What are the prophylactic agents for HA? | 1. β-blockers: good for migraines and HA due to HTN 2. Anticonvulsants: migraines, cluster HA and SUNCT 3. Ca2+ Channel blockers: cluster, migraine w/o aura 4. Antidepressants: tension headaches, migraine*given in much smaller doses 5. Muscle relaxants: good for tension HA |
| What is SUNCT | Short-lasting Unilateral Neuralgiform headache attacks with Conjuctival injection and Tearing |
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